Self-poisoning with pesticides accounts for about a third of all suicidesworldwide. To tackle this problem, the World Health Organization announced aglobal public health initiative in the second half of 2005. Plannedapproaches were to range from government regulatory action to thedevelopment of new treatments for pesticide poisoning. With broad-basedsupport, this strategy should have a major impact on the global burden ofsuicide.

Although the high rate of suicide in elderly people is conventionallyexplained as being due to greater intent to die, we have noted elderly SriLankans dying after relatively mild poisoning. Using data from cases ofyellow oleander poisoning, we investigated the effect of age on outcome in1697 patients, controlling for gender and amount ingested. In fully adjustedmodels, people over 64 years old were 13.8 (95% CI 3.6–53.0) times morelikely to die than those less than 25 years old. The high number of suicidesin elderly people globally is likely to be due, in part, to the difficultythey face in surviving the effects of both the poisoning and itstreatment.

We investigated the epidemiology of intentional self-poisoning in rural Sri Lanka by prospectively recording 2189 admissions to two secondary hospitals. Many patients were young (median age 25 years), male (57%) and used pesticides (49%). Of the 198 who died, 156 were men (case fatality 12.4%) and 42 were women (4.5%). Over half of female deaths were in those under 25 years old; male deaths were spread more evenly across age groups. Oleander and paraquat caused 74% of deaths in people under 25 years old; thereafter organophosphorous pesticides caused many deaths. Although the age pattern of self-poisoning was similar to that of industrialised countries, case fatality was more than 15 times higher and the pattern of fatal self-poisoning different.

In a double-blinded study we examined the effect of supplementing patient-controlled morphine analgesia with intercostal nerve blockade to identify if this improved analgesia and reduced morphine requirements following renal transplantation. Fifty patients were randomized to receive unilateral intercostal nerve block with either 0.5% bupivacaine or saline to the lower five intercostal nerves. Each block was performed on the side of surgical incision following the completion of surgery. Patients receiving bupivacaine blockade reported reduced pain scores and used less morphine in the initial 4 h following renal transplantation, but did not demonstrate a significant reduction in overall pain scores, total 24 h morphine requirements, or sedation scores. Two patients developed a pneumothorax, neither of which were clinically apparent at the time of diagnosis, and only detected by chest radiography. A chest radiograph should therefore be considered mandatory after intercostal nerve blockade.