A53-years-old laboratory assistant at a reputed hospital in Kathmandu recently bought aluminium phosphide tablets and ingested three of them. He started vomiting immediately, and had to be rushed into emergency.
Because of his poor cardiopulmonary status and low mentation, he was intubated and transferred to the ICU. But that did not save the patient, who died a few hours later. The reason for self-poisoning was later found to be marital discord.
Aluminum phosphide is a pesticide that is widely available across the Subcontinent because farmers use it as a fumigant to protect stored grain from insects and rodents. But increasingly more people are using this lethal inorganic compound for suicide attempts.
Aluminium phosphide releases the highly toxic phosphine gas in the presence of moisture. When ingested, therefore, it reacts with the contents of the stomach, releases phosphine and leads to serious multi-organ damage to the heart, brain, kidney and lungs. Since there is no specific antidote, the death rate is very high.
A recent large study involving 4,148 patients conducted by the Centre for Pesticide Suicide Prevention at the University of Edinburgh in collaboration with Nepal Public Health Foundation revealed that aluminium phosphide accounted for 61% of all pesticide self-poisoning fatalities in hospitals. In the same study, of the 2,535 pesticide deaths, 300 were caused by aluminium phosphide.
There has been a sharp rise in suicide deaths since the Covid-19 pandemic with widespread societal impact of lockdowns and economic difficulties on mental health of individuals. According to the Nepal Police, there were 7,141 reported deaths due to suicides nationwide in the last 12 months -- up from 6,252 the year before. Many more make attempts to end their lives.
Mental health doctors in Nepal report an increase in patients suffering anxiety, depression, post-traumatic stress disorder, hypochondria, obsessive disorders and psychotic symptoms in the population in the past two years. Subsequent studies have drawn a direct correlation between the pandemic and a spike in mental health problems due to job loss as well as increased domestic and sexual abuse during the lockdowns.
Pesticide ingestion is the second most common method for suicide in Nepal as they are cheaper, do not need prescription, and are easily available in agro-vet shops. Most farming families also have pesticides readily available in their homes.
Deaths by suicide due to pesticide ingestion are preventable, and there are evidence-based cost-effective interventions such as bans on hazardous agro-chemicals or limiting access to them.
Sri Lanka and Bangladesh have clear data on how strict bans on just a few of the pesticides commonly used for self-harm can bring down the rate of suicides rapidly and without affecting agriculture output as the government replaces them with non-lethal agrochemicals.
