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Abstract: This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to one''s own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around “love affairs,” arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term. [Copyright &y& Elsevier]

Traditionally, engineering and environment-based interventions have contributed to the prevention of malaria in Asia. However, with the introduction of DDT and other potent insecticides, chemical control became the dominating strategy. The renewed interest in environmental-management-based approaches for the control of malaria vectors follows the rapid development of resistance by mosquitoes to the widely used insecticides, the increasing cost of developing new chemicals, logistical constraints involved in the implementation of residual-spraying programs and the environmental concerns linked to the use of persistent organic pollutants. To guide future research and operational agendas focusing on environmental-control interventions, it is necessary to learn from the successes and failures from the time before the introduction of insecticides. The objective of this paper is to describe the experiences gained in Asia with early vector control interventions focusing on cases from the former Indian Punjab, Malaysia and Sri Lanka. The paper deals primarily with the agricultural engineering and land and water management vector control interventions implemented in the period 1900–1950. The selected cases are discussed in the wider context of environment-based approaches for the control of malaria vectors, including current relevance. Clearly, some of the interventions piloted and implemented early in the last century still have relevance today but generally in a very site-specific manner and in combination with other preventive and curative activities. Some of the approaches followed earlier on to support implementation would not be acceptable or feasible today, from a social or environmental point of view. [Copyright &y& Elsevier]

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts. [Copyright &y& Elsevier]

Provides insights into the reasons for people's preferences for different types of healthcare facilities. Variations of the preferences within a rural community in Sri Lanka; Role of the village treatment center as main provider for diagnosis and treatment of malaria from government facilities; Factors influencing effective catchment area of a village treatment center.

Background: Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide.Methods: WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata.Results: We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region.Limitations: High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions.Conclusion: There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally. [ABSTRACT FROM AUTHOR]

Abstract: Improving sanitation and hygiene to prevent infectious diseases is of high priority in developing countries. This study attempts to gain in-depth understanding of hygiene and sanitation perceptions and practices among four Ethnic Minority Groups (EMGs) in a rural area of northern Vietnam. It is based on extensive participatory observations in 4 villages and 20 case households over a period of six months (May–October 2008). In addition, 10 key informants and 60 household-members were interviewed and 4 focus group discussions conducted. The study found that among the four selected EMGs the cultural perceptions of hygiene and sanitation which inform everyday hygiene practices did not differ substantially and were similar to hygiene explanations found in the rural majority population elsewhere in Vietnam. However, the difficult living conditions, particularly in highland communities, reinforce a sense of marginalization among the EMGs, which had great impact on how they perceive and respond to government sanitation interventions. The enclosed latrines promoted by authorities are met with reluctance by the EMGs due to cultural perceptions of the body as permeable and therefore, vulnerable to ’dirty air’ such as bad smells from human faeces. In addition, the prioritization of specific sanitation hardware solutions by the central government aimed at increasing coverage creates expectations and dependency among the EMGs that hygiene ’comes from the outside society’, resulting in low levels of community initiated actions. Based on these findings, we suggest that future hygiene promotion strategies aim for a closer match between community priorities and government hygiene policies, e.g. by allowing for a larger diversity of low-cost sanitation solutions. Scaling up participatory community-based hygiene promotion is also recommended to curb dependency and spark initiatives in ethnic minority communities. Finally, interventions should focus on hygiene “software” - promoting hygiene behaviour changes known to effectively prevent hygiene related diseases. [Copyright &y& Elsevier]

Abstract: The use of human excreta as fertiliser in agriculture is a common practice in parts of South East Asia benefiting production but at the same time a risk factor for increased helminth infections. This paper describes the hygienic handling of human excreta for use in agriculture in Central Vietnam from a practical farming perspective presenting the farmers perceived health risks and benefits of its use. Further, in the study findings are discussed relating to the new Vietnamese guidelines for the use of human excreta in agriculture to their implications on an on-farm context. A total of 471 households in five communes responded to a structured questionnaire. This survey was supplemented by focus group discussions, key informant interviews and participant observations. More than 90% of the surveyed households used their own excreta as fertiliser and a total of 94% composted the excreta before use, either inside or outside the latrine. However, due to the prevailing design of the latrine and the three annual cropping seasons, it was found that for a minimum of one cultivation season per year 74% of the households will have only 3–4 months for composting before the input is needed in production, which is short of the 6 months stipulated in the national guidelines. The community associated great benefits from using human excreta in agriculture, especially if composted, and did not associate risks with the use of composted excreta if it was dry and lacked odour. It is recommended that the guidelines be revised and attempts made to identify ways of reducing the time needed to ensure the die-off of helminth eggs, including the use of pH regulators, such as an increased use of lime in the latrines. [Copyright &y& Elsevier]