Acute poisoning and suicide trends in Sri Lanka: Alcohol a cause for concern

According to the World Health Organization Sri Lanka has the seventh highest global suicide rate.1 The majority of Sri Lankan suicide attempts are as a result of ingestion of pesticides, insecticides and herbicides.2 Sri Lanka has a predominantly agrarian economy and thus a large rural population. It is very difficult to get up to date figures concerning acute poisoning and suicide in Sri Lanka and the latest regional data the authors could obtain was from 1994. These are reproduced in table 1. Data provided by the Sri Lankan National Poison Information Centre in 2000 confirmed that the majority of poisoning attempts were in rural areas (n=30,207) (n=852 3% deaths). In rural areas, the most common form of poisoning from snake bites (n=14,003, (52, 0.4% deaths) followed by all kinds of agro-chemicals (n=6887) (n=579, 8% deaths), non-medical substances (n=5574) (n=168, 3% deaths) and finally drug medicaments and biological substances (n=3705 (n=56, 1.5% deaths). Of even greater concern were trends also from the Sri Lankan National Poisoning Information Centre showing the acute poisoning trends from 1990-2000 in three rural districts (Anuradhapura, Polonnaruwa and Kurunegala). In 1990, the number of cases of acute poisoning by agrochemicals in these districts was 487 and 54 deaths. Equivalent figures for 2000 were 819 and 74 deaths. This was a rise of 41% in incidents of acute poisoning and 27% in deaths. Three factors are likely to interact to explain the high rates of suicide and deliberate self-harm in Sri Lanka particularly in rural areas.3 These are a lack of medical facilities, easily availability of organophosphorus and a lack of cheap antidotes. A long-term civil war and the precariousness of subsistence farming in the developing world exacerbate this. “In a moment of extreme stresswhen crops failwhen losses imposed by the war seem insurmountable – there are enough reasons at times – people just grab the nearest thing and drink it.”3 Although included amongst the poisoning data as a non-medical substance the role of alcohol in acute poisoning or suicide has received scant research attention. (M.Eddleston, personal communication). This is of concern because recent data indicates that Sri Lankan alcohol consumption is on an upward trend. It is difficult to get precise Sri Lankan alcohol consumption figures because legal alcohol is comparatively expensive and in poorer rural areas an illicitly distilled moonshine called Kasippu is often drunk. However there are indicators that Sri Lanka has an increasing alcohol problem, despite the fact that the majority of the population do not drink. According to the GENACIS project 63% have never consumed alcohol.5 The same study found that the rate of hazardous drinking was nearly 16%. There has been a 44% rise in deaths due to alcoholic liver disease from 19911999.6 The same publication indicates that there has been a more than fourfold increase in the per capita level of legally purchased alcohol from 1981 (1.81) – 2003 (7.37). If these trends continue then there is likely to be a small subgroup who will present a disproportionately large health burden. The authors are currently seeking funding to examine this concept further with the aim of developing targeted alcohol-related health promotion interventions.