Self-poisoning in rural Sri Lanka: small-area variations in incidence
Identifieur interne : 000914 ( Main/Exploration ); précédent : 000913; suivant : 000915Self-poisoning in rural Sri Lanka: small-area variations in incidence
Auteurs : Celie Manuel [Danemark, Sri Lanka] ; David J. Gunnell [Royaume-Uni] ; Wim Van Der Hoek [Danemark] ; Andrew Dawson [Sri Lanka, Australie] ; Ishika K. Wijeratne [Sri Lanka] ; Flemming Konradsen [Danemark, Sri Lanka]Source :
- BMC Public Health [ 1471-2458 ] ; 2008.
Abstract
Self-poisoning is one of the most common methods of suicide worldwide. The intentional ingestion of pesticides is the main contributor to such deaths and in many parts of rural Asia pesticide self-poisoning is a major public health problem. To inform the development of preventive measures in these settings, this study investigates small-area variation in self-poisoning incidence and its association with area-based socioeconomic and agricultural factors.
Ecological analysis of intentional self-poisoning in a rural area (population 267,613) of Sri Lanka in 2002. The geographic distribution of cases was mapped to place of residence. Using administrative division (GN), median population size 1416, as unit of analysis, associations with socioeconomic and agricultural indicators were explored using negative binomial regression models.
The overall incidence of intentional self-poisoning in the study area was 315 per 100,000 (range: 0 – 2168 per 100,000 across GNs). Socioeconomic disadvantage, as indexed by poor housing quality (p = 0.003) and low levels of education (p < 0.001) but not unemployment (p = 0.147), was associated with a low self-poisoning incidence. Areas where a high proportion of the population worked in agriculture had low overall levels of self-poisoning (p = 0.002), but a greater proportion of episodes in these areas involved pesticides (p = 0.01). An association with extent of cultivated land was found only for non-pesticide poisoning (p = 0.01).
Considerable small-area variation in incidence rates of intentional self-poisoning was found. The noteworthy concentration of cases in certain areas and the inverse association with socioeconomic deprivation merit attention and should be investigated using individual-level exposure data.
Url:
DOI: 10.1186/1471-2458-8-26
PubMed: 18215262
PubMed Central: 2262074
Affiliations:
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Box 2099, 1014 Cph K</wicri:regionArea><wicri:noRegion>1014 Cph K</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>South Asian Clinical Toxicology Research Collaboration, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation></author><author><name sortKey="Gunnell, David J" sort="Gunnell, David J" uniqKey="Gunnell D" first="David J" last="Gunnell">David J. Gunnell</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Social Medicine, University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Social Medicine, University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. 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Wijeratne</name><affiliation wicri:level="1"><nlm:aff id="I6">Urban Development Authority, GIS Centre, "Sethsiripaya", Battaramulla, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>Urban Development Authority, GIS Centre, "Sethsiripaya", Battaramulla</wicri:regionArea><wicri:noRegion>Battaramulla</wicri:noRegion></affiliation></author><author><name sortKey="Konradsen, Flemming" sort="Konradsen, Flemming" uniqKey="Konradsen F" first="Flemming" last="Konradsen">Flemming Konradsen</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K</wicri:regionArea><wicri:noRegion>1014 Cph K</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>South Asian Clinical Toxicology Research Collaboration, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18215262</idno><idno type="pmc">2262074</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2262074</idno><idno type="RBID">PMC:2262074</idno><idno type="doi">10.1186/1471-2458-8-26</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">000079</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000079</idno><idno type="wicri:Area/Pmc/Curation">000079</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000079</idno><idno type="wicri:Area/Pmc/Checkpoint">000161</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000161</idno><idno type="wicri:Area/Ncbi/Merge">000205</idno><idno type="wicri:Area/Ncbi/Curation">000205</idno><idno type="wicri:Area/Ncbi/Checkpoint">000205</idno><idno type="wicri:Area/Main/Merge">000914</idno><idno type="wicri:Area/Main/Curation">000914</idno><idno type="wicri:Area/Main/Exploration">000914</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Self-poisoning in rural Sri Lanka: small-area variations in incidence</title><author><name sortKey="Manuel, Celie" sort="Manuel, Celie" uniqKey="Manuel C" first="Celie" last="Manuel">Celie Manuel</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K</wicri:regionArea><wicri:noRegion>1014 Cph K</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>South Asian Clinical Toxicology Research Collaboration, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation></author><author><name sortKey="Gunnell, David J" sort="Gunnell, David J" uniqKey="Gunnell D" first="David J" last="Gunnell">David J. Gunnell</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Social Medicine, University of Bristol, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Social Medicine, University of Bristol, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K</wicri:regionArea><wicri:noRegion>1014 Cph K</wicri:noRegion></affiliation></author><author><name sortKey="Dawson, Andrew" sort="Dawson, Andrew" uniqKey="Dawson A" first="Andrew" last="Dawson">Andrew Dawson</name><affiliation wicri:level="1"><nlm:aff id="I3">South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>South Asian Clinical Toxicology Research Collaboration, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Department of Clinical Medicine, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>Department of Clinical Medicine, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I5">School of Population Health, University of Newcastle, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Population Health, University of Newcastle</wicri:regionArea><wicri:noRegion>University of Newcastle</wicri:noRegion></affiliation></author><author><name sortKey="Wijeratne, Ishika K" sort="Wijeratne, Ishika K" uniqKey="Wijeratne I" first="Ishika K" last="Wijeratne">Ishika K. Wijeratne</name><affiliation wicri:level="1"><nlm:aff id="I6">Urban Development Authority, GIS Centre, "Sethsiripaya", Battaramulla, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>Urban Development Authority, GIS Centre, "Sethsiripaya", Battaramulla</wicri:regionArea><wicri:noRegion>Battaramulla</wicri:noRegion></affiliation></author><author><name sortKey="Konradsen, Flemming" sort="Konradsen, Flemming" uniqKey="Konradsen F" first="Flemming" last="Konradsen">Flemming Konradsen</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of International Health, Institute of International health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Building 16, P.O. Box 2099, 1014 Cph K</wicri:regionArea><wicri:noRegion>1014 Cph K</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Sri Lanka</nlm:aff><country xml:lang="fr">Sri Lanka</country><wicri:regionArea>South Asian Clinical Toxicology Research Collaboration, University of Peradeniya</wicri:regionArea><wicri:noRegion>University of Peradeniya</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Self-poisoning is one of the most common methods of suicide worldwide. The intentional ingestion of pesticides is the main contributor to such deaths and in many parts of rural Asia pesticide self-poisoning is a major public health problem. To inform the development of preventive measures in these settings, this study investigates small-area variation in self-poisoning incidence and its association with area-based socioeconomic and agricultural factors.</p></sec><sec sec-type="methods"><title>Methods</title><p>Ecological analysis of intentional self-poisoning in a rural area (population 267,613) of Sri Lanka in 2002. The geographic distribution of cases was mapped to place of residence. Using administrative division (GN), median population size 1416, as unit of analysis, associations with socioeconomic and agricultural indicators were explored using negative binomial regression models.</p></sec><sec><title>Results</title><p>The overall incidence of intentional self-poisoning in the study area was 315 per 100,000 (range: 0 – 2168 per 100,000 across GNs). Socioeconomic disadvantage, as indexed by poor housing quality (p = 0.003) and low levels of education (p < 0.001) but not unemployment (p = 0.147), was associated with a low self-poisoning incidence. Areas where a high proportion of the population worked in agriculture had low overall levels of self-poisoning (p = 0.002), but a greater proportion of episodes in these areas involved pesticides (p = 0.01). An association with extent of cultivated land was found only for non-pesticide poisoning (p = 0.01).</p></sec><sec><title>Conclusion</title><p>Considerable small-area variation in incidence rates of intentional self-poisoning was found. The noteworthy concentration of cases in certain areas and the inverse association with socioeconomic deprivation merit attention and should be investigated using individual-level exposure data.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>Danemark</li><li>Royaume-Uni</li><li>Sri Lanka</li></country></list><tree><country name="Danemark"><noRegion><name sortKey="Manuel, Celie" sort="Manuel, Celie" uniqKey="Manuel C" first="Celie" last="Manuel">Celie Manuel</name></noRegion><name sortKey="Konradsen, Flemming" sort="Konradsen, Flemming" uniqKey="Konradsen F" first="Flemming" last="Konradsen">Flemming Konradsen</name><name sortKey="Van Der Hoek, Wim" sort="Van Der Hoek, Wim" uniqKey="Van Der Hoek W" first="Wim" last="Van Der Hoek">Wim Van Der Hoek</name></country><country name="Sri Lanka"><noRegion><name sortKey="Manuel, Celie" sort="Manuel, Celie" uniqKey="Manuel C" first="Celie" last="Manuel">Celie Manuel</name></noRegion><name sortKey="Dawson, Andrew" sort="Dawson, Andrew" uniqKey="Dawson A" first="Andrew" last="Dawson">Andrew Dawson</name><name sortKey="Dawson, Andrew" sort="Dawson, Andrew" uniqKey="Dawson A" first="Andrew" last="Dawson">Andrew Dawson</name><name sortKey="Konradsen, Flemming" sort="Konradsen, Flemming" uniqKey="Konradsen F" first="Flemming" last="Konradsen">Flemming Konradsen</name><name sortKey="Wijeratne, Ishika K" sort="Wijeratne, Ishika K" uniqKey="Wijeratne I" first="Ishika K" last="Wijeratne">Ishika K. Wijeratne</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Gunnell, David J" sort="Gunnell, David J" uniqKey="Gunnell D" first="David J" last="Gunnell">David J. Gunnell</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Dawson, Andrew" sort="Dawson, Andrew" uniqKey="Dawson A" first="Andrew" last="Dawson">Andrew Dawson</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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