Improving surveillance of pesticide poisoning and trialling auto-injectors for pre-hospital treatment.

Occupational poisoning of farmers with pesticides has been recognised by the World Health Organisation as a global health problem since 1990. 

A major problem identified by farming communities is the delay to reaching hospital (often several hours away) for antidote administration. During transfer, treatment is unavailable and poisoning often progresses.

At the same time, there is a gradual shift away from older, more toxic pesticides to newer less hazardous ones. While this shift is positive, there are few data on the acute effects of these newer pesticides.


What are we doing?


Testing feasibility of auto-injectors

We are testing the feasibility of using auto-injectors in rural communities to help treat pesticide poisoning.

Atropine auto-injectors have already been developed for treatment of those affected by organophosphorus nerve agents. They allow an antidote to be rapidly administered by injection into thigh muscles. Their use does not need high level training and civilians have been taught to use them safely.

However, it is currently unclear whether it is possible for non-professionals to use the auto-injectors in rural LMIC regions to help prevent deaths from pesticide poisoning.

Our community engagement activities show that there is enthusiasm from both inhabitants and healthcare workers to explore the possibility of using auto-injectors in villages. However, there are multiple potential barriers to their use, for example who will store them, who will administer the injections, and whether they can be safely used for all pesticide exposures.

Therefore, before trials can be designed, there is a need to work with communities (including farmers and community health care workers) to find out how they might practically use these antidotes.

We are working with six villages in North Central Province, Sri Lanka, which commonly use pesticides in agriculture. 

Stage 1: Scoping 

We will undertake participatory research with communities living in two villages to identify acceptable and feasible methods for introducing auto-injectors.

Stage 2: Developing protocol for provision of auto-injectors

We will use the information gained to develop a protocol for the provision of auto-injectors into three villages.

Stage 3: Observing use of auto-injectors

We will implement the protocol in all 6 villages included in the study for 2 years. We will develop a mobile phone text alerting system that will allow villagers to inform the research team when any casesnoccur, so that interviews can be carried out soon after the event.


If we are successful in showing that auto-injectors can be stored and used safely in rural villages, this will lead to the development of a large clinical trial to test their effectiveness in preventing deaths from pesticide poisoning.


Improving surveillance

Through improved surveillance, we aim to identify the newer pesticides that result in illness and provide an improved estimate of the number of patients with acute pesticide poisoning in rural communities.

We are combining two existing surveillance systems:

  • Pesticide Action Network (PAN) UK's simple mobile App that allows farmers to record their illnesses from pesticide use.
  • A Sri Lanka hospital surveillance system that currently covers 110 hospitals and 2.1 million people. This system has been developed through two previous randomised controlled trials. It aims to identify the pesticide involved for all pesticide poisoning patients admitted to these hospitals.

We have long-standing excellent relationships with the community that will allow us to work with farmers on their occupational exposures, train them about the App, and link the resulting data to our unique hospital surveillance system.


Work Package 2 Investigators

Professor Michael Eddleston (Programme Lead) The University of Edinburgh
Dr Alice Street The University of Edinburgh
Dr Jane Brandt Sørensen University of Copenhagen, Department of Public Health

Dr Manjula Weerasinghe

Rajarata University
Dr Ayanthi Karunarathne Ministry of Health, Sri Lanka