Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

/pdf/the-global-distribution-of-fatal-pesticide-self-poisoning-ulsr1od2bw.pdf

The global distribution of fatal pesticide self-poisoning: systematic review

Deliberate self-harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self-poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self-harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self-harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self-harm, gaining a notoriety amongst both health-care workers and public. Self-poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self-poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long-term disabilities world-wide. Self-poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self-harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self-poisoning in the developing world.

/pdf/patterns-and-problems-of-deliberate-self-poisoning-in-the-3c8eojf5w7.pdf

Patterns and problems of deliberate self‐poisoning in the developing world

Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume.

Sub-Saharan Africa is undergoing epidemiological transition. Stroke and other vascular diseases increasingly contribute to the burden of disease. There are no systematic reviews of stroke mortality, prevalence, incidence, and case fatality. We combined a thorough search and critical assessment of the published research. Stroke mortality is as high, perhaps higher, than in high-income regions and increases with age in sub-Saharan Africa as in high-income countries, but the absolute number of stroke deaths remains low. There are no adequate community-based stroke incidence studies. Hospital-based incidence is lower than in high-income regions, but higher in young people, possibly due to hospital admission bias. There are no community-based data on case fatality, but hospital-based case fatality is higher than elsewhere. The prevalence of stroke is lower than in high-income regions, but disabling stroke is as prevalent. As the region develops economically, the incidence of stroke and other vascular diseases will increase unless interventions are implemented. Only community-based incidence studies will accurately reveal the burden of stroke.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(07)70002-9.pdf

Burden of stroke in black populations in sub-Saharan Africa

Stroke mortality in urban and rural Tanzania

Organophosphate pesticide poisoning in 50 patients treated at the Tikur Anbessa Hospital over a period of 6 years is described. Most of the cases were attempted suicide (94%). The majority of the patients presented with the typical clinical features of Parasympathetic overactivity. Atropine was the mainstay of treatment. Mortality from organophosphate pesticide poisoning was 20%. There is a strong need to device a national system of control of pesticides and educate the public about the dangers of pesticides.

Organophosphate pesticide poisoning in 50 Ethiopian patients

An Ethiopian Training Program in Neurosurgery with Norwegian Support

BACKGROUND Disc degeneration is common, the pattern and prevalence of various signs of disc degeneration is unclear Neither hospital nor population-based data or study is available on lumbar disc diseases in Ethiopia The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years Lumbar disc disease refers to a collection of degenerative disorders that can lead to low back pain as people age OBJECTIVE Review the pattern, clinical manifestation, diagnostic method and management decision of patients with degenerative lumbar disc disease at the neurosurgical referral clinic of Tikur Anbessa Hospital during the fiscal year 2009 PATIENTS AND METHODS This is a hospital based cross sectional study of patterns of patients with lumbar disc diseases seen at the neurosurgical referral clinic, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Surgery, Addis Ababa, Ethiopia in the period between January and December 2009 (12 months) Data taken while clerking patients and patents' medical record at referral clinic were main source of information Standardized and structured questionnaire prepared for this purpose were used to analyze the sociodemographic, clinical manifestation, diagnostic modalities such as lumbar myelography, CT and MRI, patterns of disc disease in lumbar spine at NSRC with reference to age, severity and level distribution were reviewed Difference in proportions were examined using Chi-square test RESULTS The study reviews 364 patients with lumbar disc diseases at the neurosurgical referral clinic, TASH over the one-year period (2009), their age ranged from 20 to 82 years (median, 440) Pain, numbness and neurologic claudication were the three most common presenting symptoms, occurring in 337(925%), 232 (6376%) and 111 (305%) respectively Lumbar MRI was the statistically significant investigation modality of choice (p < 00001) Two hundred thirty-five (701%) patients had disc prolaps (P < 00001), 185% had disc bulge Lumbar degenerative disc disease was most frequently seen at L4-L5 level in 309 (545%) patients (P < 00001) both L4-L5 and L5-S1 accounted for 791% of the disc displacements On MRI, disc displacements, were central in 612%, lateral in 93% and posterolateral in 158%

Review of lumbar disc diseases at Tikur Anbessa Hospital.

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Fall and Road traffic accident are the main etiologic factor. Objective: The aim of this study was to asses local hospital patterns of spinal injury and compare them with published reports. Methods and Patients: This is a hospital based cross sectional study of patterns of patients with spine and spinal cord injury seen at the Emergency OPD, Tikur Anbessa Specialized Teaching Hospital (TASTH), Department of Neurosurgery, Addis Ababa, Ethiopia in the period between April 2008 and March 2012. Data was collected using structured questionnaires. The variables included were the Socio-demographic such as age sex, distance of patients’ residence area from the TAH. In addition to the above profiles, causes of injuries, Occupation, diagnosis, time spent between arrival and Admission and decision taken at OPD level. Differences in proportions were examined using Chi-square test. Results: A statistically significant male predominance (84.9 %)(p, 0.0001) was observed, the mean age was 32.8 years, with range10 to 84 years. Mean duration of presentation to TASH was 4.3 days with a range 1 hour-60 days, Fall from height (P<0.001) and Road traffic collisions were the main cause of spine and spinal cord injuries in 36.4% and 32.9% of the patients respectively Most often the cervical spine was involved (33.0%), Sixty-nine (17.9%) patients had associated injuries, majority of respondents (25.5%) were farmers, Majority belonged to ASIA A grade. All the deaths, 7(8.3%) occurred in patients with complete cervical spine lesion. Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete and the case incidence from fall was remarkably high. Key words: Spinal cord injury. Patterns, Ethiopia

/pdf/pattern-of-spine-and-spinal-cord-injuries-in-tikur-anbessa-2gj37ku5di.pdf

Pattern of spine and spinal cord injuries in tikur anbessa hospital, ethiopia.

We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.

Epidural and para spinal thoracic hydatidosis presenting with progressive paraparesis and paraplegia: a case report.

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