Acute poisoning, especially deliberate self-poisoning
with agricultural pesticides, is an emerging global public health
problem, but reliable incidence estimates are lacking. Only a few
previous studies have assessed the impact of regulatory or other
preventive measures. Objective. To estimate trends in incidence
and causes of acute poisoning over time in rural Sri Lanka, and to
assess the possible impact of policies that aimed to restrict availability
of highly toxic pesticides. Methods. Time series of incidence of
acute poisoning based on retrospective in-patient records of six government
hospitals in southern Sri Lanka from 1990 to
2002. Results. Data of 8,110 admissions for acute poisoning were
available for analysis. Most cases were young adults, who deliberately
self-poisoned themselves with pesticides, males outnumbering
females. Average incidence rate of acute poisoning over the study
period was 318 per 100,000 (95% confidence interval [CI], 311 to
325). Incidence of all poisoning showed an increase over the period
of study. However, this increase was lower for pesticide poisoning,
and the mortality rate and case fatality ratio of pesticides went
down towards the end of the 1990s. The decline in mortality was
attributed to regulatory controls for the group of highly hazardous
organophosphorus compounds implemented in 1995 and for the
organochlorine endosulfan in 1998. Conclusions. Regulatory control
of highly toxic pesticides provides important health benefits,
especially in terms of lower number of deaths from self-poisoning.
However, despite the positive effect of these bans, many deaths
from pesticide self-poisoning still occur after ingestion of agricultural
pesticides classified as only moderately poisonous.