Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia: a study protocol for a stepped-wedge cluster randomised controlled trial
Matthew Miller,
Chris Metcalfe,
Keith Hawton,
Nicholas Turner,
Suneth Agampodi,
Lizell Bustamante Madsen,
Michael Eddleston,
Melissa Pearson,
Shaluka Jayamanne,
Flemming Konradsen,
Manjula Weerasinghe,
Kalpani Dissanayaka,
Sandamali Rajapaksha,
Thilini Agampodi,
David J Gunnell,
Simon Parker,
Jayakody Arachchige Sumith,
Ayanthi Karunarathne,
Dilani Rodrigo,
Dissanayake Abeysinghe,
Chathuranga Piyasena,
Rajaratnam Kanapathy,
Sundaresan Thedchanamoorthy
Affiliations
Matthew Miller
3 Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
Chris Metcalfe
Bristol Trials Centre, University of Bristol, Bristol, UK
Keith Hawton
1 Department of Psychiatry, University of Oxford, Oxford, UK
Nicholas Turner
8 Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
Suneth Agampodi
6 Centre for Public Health, Anuradhapura, Sri Lanka
Lizell Bustamante Madsen
Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Michael Eddleston
3 Centre for Pesticide Suicide Prevention, and Pharmacology, Toxicology and Therapeutics, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Melissa Pearson
Faculty of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
Shaluka Jayamanne
Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
Flemming Konradsen
4 Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Manjula Weerasinghe
2 South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Kalpani Dissanayaka
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Sandamali Rajapaksha
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Thilini Agampodi
1 Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
David J Gunnell
Population Health Sciences, University of Bristol, Bristol, UK
Simon Parker
Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
Jayakody Arachchige Sumith
Office of the Registrar of Pesticides, Peradeniya, Sri Lanka
Ayanthi Karunarathne
Tertiary Care Services, Ministry of Health, Colombo, Sri Lanka
Dilani Rodrigo
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Dissanayake Abeysinghe
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Chathuranga Piyasena
South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Rajaratnam Kanapathy
1 Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
Sundaresan Thedchanamoorthy
Department of Clinical Sciences, Faculty of Health Care Sciences, Eastern University, Batticaloa, Sri Lanka
Introduction Pesticide self-poisoning kills an estimated 110 000–168 000 people worldwide annually. Data from South Asia indicate that in 15%–20% of attempted suicides and 30%–50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a ‘gatekeeper’ training programme for vendors to enable them to identify individuals at high risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention.Methods and analysis A stepped-wedge cluster randomised trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24 hours, total number of all forms of self-harm and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pretraining and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19.Ethics and dissemination The Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30), and the ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals.Trial registration number SLCTR/2019/006, U1111-1220-8046.
