The cost of highly hazardous pesticide self-poisoning in India

Over 700,000 people die by suicide annually and 80% of these deaths occurring in low and middle-income countries (LMICs). Suicide by pesticide ingestion is the second most common means of suicide globally - 10-20% of all suicide deaths are by pesticide self-poisoning. Most of these deaths are acts of self-harm with no/low suicidal intent. The burden of pesticide suicide is felt greatest in poor agricultural communities in Asia, Africa and Latin America, where farmers have direct access to acutely toxic highly hazardous pesticides (HHP).

The Sustainable Development Goals (SDGs) have made reducing suicide a key target for improving global health. Work conducted at the University of Bristol in collaboration with other institutes led to the WHO recommending the banning of HHP to achieve the goal of reducing suicide mortality by a third by 2030.

1-in-4 suicides occur in India and ~30% of these deaths are by pesticide ingestion -the state of Maharashtra had the most suicide deaths in 2021. Whilst several bans of HHP have been enacted in India there are still several HHP still readily available in country.

Work is needed to convince governments to continue to ban HHP in LMIC–many of these pesticides are already banned in high-income countries over health concerns.

Aims and objectives

This project aims to understand the financial costs of suicide and self-poisoning using established infrastructure in India. The study will take a societal perspective which considers all costs regardless of who pays them. This includes non-healthcare costs, such as productivity losses, informal care, and out-of-pocket expenses.

Specific research questions may include:

1. What is the cost of suicide deaths in Maharashtra and does the costs vary by method (i.e. HHP vs. other self-poisoning vs. other methods)
2. What is the cost of hospital presenting self-poisoning in Maharashtra and does the costs vary by method (i.e. HHP vs. other pesticide vs. other poisons)?

Methodology

The study will include primary data collection which utilises existing infrastructure established in Maharashtra. The project will utilise case-control study designs. The PhD project will take a societal perspective and collect cost data associated with a suicide death or non-fatal self-poisoning via questionnaires, record reviews and other sources. There is potential to collect additional risk factor data to further understand whether people who self-harm using HHP differ from those using other poisons. Additionally, data on the subjective economic impact of the suicide death or self-poisoning will be collected from the individual who self-harmed and family members (where possible).

Using the cost data collected, the student will compare the cost of a HHP suicide death with two comparators: i) suicide deaths by other means of self-poisoning; and ii) other methods (e.g. hanging). A similar comparison will also be done using data from hospital presenting self-poisoning (Yavatmal district hospital), where the cost of non-fatal HHP self-poisoning is compared with: i) other pesticides; and ii) other poisons presenting to the same hospital.

The student will develop skill in health economics and mental health. Given the project focus and expertise of the supervisory/collaborating team, the student will gain skills to develop as a leader in global health.

Apply for this project

This project will be based in Bristol Medical School - Population Health Sciences.

Please contact brms-pgradmin@bristol.ac.uk for further details on how to apply.

Apply now!