Analysis of Recent Situation of Pesticide Poisoning in Bangladesh: Is There a Proper Estimate?

Background: Pesticide poisoning is a common method of suicide attempt and less commonly accidental poisoning in Bangladesh. This review for the first time estimated the extent and characteristics of pesticide poisoning in Bangladesh and explored existing limitations in methodologies of studies done on poisoning in the country. Methods: A narrative search in electronic medical databases including MEDLINE, Google Scholar and Banglajol was carried out. Search terms used were "Bangladesh", "pesticide", "poisoning" and "organophosphate". Relevant studies were collected and assessed for their originality. Organization reports were also collected. Studies after the year 2000 were only selected. Methodologies of the studies were carefully scrutinized. Results: Estimated case load of poisoning in hospitals of Bangladesh was 7.1% (CI 6.9-7.2) of total admissions. Pesticide poisoning accounted for 39.1% (CI 37.6-40.6%) of total poisoning cases admitted in different levels of hospitals in Bangladesh. Majority of them were due to WHO class-II pesticides (moderately hazardous). Reported frequency of different pesticides includes organophosphate compounds (OPCs) in 89.8%, rodenticides in 4.3%, carbamates in 4.0%, unknown compounds in 1.6% and pyrethroids in 0.3% of cases. Pesticide poisoning was responsible for 72.6% (CI 68.0-76.8) of total poisoning related deaths. Approximately 0.7 deaths per 100,000 population was due to pesticide poisoning. Reporting the frequency of chemical nature of pesticides varied significantly with methodology used for case identification (P < 0.001). In studies that toxidromic assessment was used, most cases were treated as OPC poisoning. In studies that applied sample identification by evaluation of container/pack and reading its label, over 30% of cases were due to carbamates. Presence of only one toxicological analysis center in the country has made routine chemical identification practically impossible.  Conclusion: Pesticide poisoning is responsible for great number of admissions and deaths in Bangladesh. Creating a register of commercially available pesticides in each region for rapid identification of nature of the pesticide is recommended.