Pesticides are widely used in agriculture and public-health programmes, but their toxic properties also create an important risk of acute poisoning. The World Health Organization (WHO) classifies pesticides according to acute hazard and identifies a group of highly hazardous pesticides that can cause severe or irreversible harm even after relatively small exposures [1]. In many low- and middle-income countries, these compounds remain readily accessible in agricultural settings, where safe storage, regulation and rapid access to emergency care may be inconsistent [2].

Intentional self-poisoning with pesticides has been a major contributor to global suicide mortality. A systematic review of data from 2006-2015 estimated that pesticide self-poisoning remained an important cause of suicide deaths worldwide, particularly in rural Asia [3]. WHO has therefore identified restriction of access to highly hazardous pesticides as an evidence-based suicide-prevention intervention and has issued specific guidance for pesticide registrars and regulators [4,5].

The problem is especially relevant to India because agriculture employs a large population and pesticides are commonly available in rural communities. A nationally representative Indian mortality survey found that poisoning accounted for a substantial proportion of suicides and that many poisoning deaths involved pesticides [6]. More recently, a systematic review of lethal poisoning in India from 1999 to 2018 found pesticides to be the dominant class of poison reported in fatal cases, with organophosphorus insecticides remaining particularly important across regions [7]. Autopsy-based studies from India have also shown a predominance of young adults and males among fatal poisoning cases [8].

Medico-legal autopsy data provide an opportunity to characterize fatal pesticide poisoning and identify demographic and circumstantial patterns that may assist prevention and health-system planning. The present study was therefore undertaken to describe the age and sex distribution, occupation, locality, manner of death and period of survival among fatal pesticide poisoning cases.

of Forensic Medicine, Government Medical College, Latur. Study period: The study was conducted from 1 January 2017 to 31 May 2018. Study population: All fatal cases with a history consistent with pesticide poisoning that were brought for medico-legal autopsy during the study period and fulfilled the study criteria were included. A total of 156 cases were analysed. Exclusion criteria: Decomposed bodies and cases in which the available history and records were insufficient to classify the death as pesticide poisoning were excluded. Data collection: Information regarding age, sex, occupation, place of residence, circumstances and manner of poisoning, treatment history and period of survival was obtained from police inquest papers, available clinical records, accompanying relatives or investigating personnel and medico-legal autopsy documentation. The manner of death was classified as suicidal, accidental, or homicidal on the basis of the available medico-legal information. Statistical analysis: Data were entered in Microsoft Excel 2016. Descriptive statistics were used and categorical variables are presented as frequencies and percentages. Ethical considerations: The study involved analysis of medico-legal autopsy records. Institutional Ethics Committee approval was taken.

During the study period, 1,950 medico-legal autopsies were conducted. Of these, 250 (12.8%) were deaths due to poisoning and 156 were attributed to fatal pesticide poisoning. Thus, pesticide poisoning accounted for 62.4% of all poisoning deaths and 8.0% of all medico-legal autopsies. Among the 156 fatal pesticide poisoning cases, 129 (82.7%) were male and 27 (17.3%) were female, giving a male-to-female ratio of approximately 4.8:1. The largest age group was 20-29 years, comprising 134 (85.9%) cases (Table 1). With respect to occupation, 138 (88.5%) cases were engaged in agriculture and 18 (11.5%) were in non-agricultural occupations. Among agricultural cases, 129 (93.5%) were male and nine (6.5%) were female (Table 2). Most victims were residents of rural areas: 144 (92.3%) cases were rural and 12 (7.7%) were urban (Table 3). Based on the available clinical and medico-legal information, 120 (76.9%) deaths were suicidal, 30 (19.2%) were accidental and six (3.8%) were homicidal (Table 4). Regarding survival after poisoning, 55 (35.3%) victims survived for 6-12 hours, while 52 (33.3%) were brought dead. Twenty-six (16.7%) survived for 12-24 hours, 16 (10.3%) for 1-3 days and seven (4.5%) for 3-7 days (Table 5).

Table 1. Age- and sex-wise distribution of fatal pesticide poisoning cases

Note: Sex-specific percentages within each age group are row percentages; total-column percentages use 156 as the denominator.

Table 2. Sex and occupation-wise distribution of cases

Table 3. Sex and locality-wise distribution of cases

Table 4. Distribution according to manner of death

Table 5. Distribution according to period of survival

The present study describes the epidemiological pattern of 156 fatal pesticide poisoning cases examined at a tertiary medico-legal centre in Maharashtra. Pesticide poisoning accounted for 62.4% of all poisoning deaths and 8.0% of all medico-legal autopsies during the study period. These findings underline the continuing importance of pesticides in fatal poisoning in India. In a systematic review covering Indian studies from 1999 to 2018, Karunarathne et al. found pesticides to be the dominant class of poison reported in lethal poisoning, with organophosphorus insecticides remaining important across the country [7]. The present study did not contain sufficiently detailed toxicological data to compare specific pesticide classes and therefore conclusions regarding a particular compound should not be drawn from these data. A marked male predominance was observed: 82.7% of victims were male. The largest proportion of deaths occurred in the 20-29-year age group. Goswami et al., in a medico-legal autopsy study from north-eastern India, also reported male predominance and the highest proportion of acute poisoning deaths among young adults aged 21-30 years [8]. Nationally representative Indian data have similarly shown that suicide mortality is concentrated substantially in younger age groups [6]. The predominance of young adults in the present autopsy series is therefore epidemiologically plausible, although the very high proportion observed here may reflect local patterns, referral characteristics, or the case definition used. Agricultural workers represented 88.5% of cases and 92.3% of victims were from rural areas. This pattern is consistent with the occupational and geographic availability of pesticides in farming communities. The historical and contemporary literature has repeatedly highlighted the particular burden of pesticide exposure and self-poisoning in rural agricultural populations in South Asia [9]. Studies from the Sundarban region of India have documented pesticide self-poisoning among farming communities together with unsafe household storage and limited awareness of pesticide-related health risks [10,11]. However, occupation and rural residence should not be interpreted as causal factors on the basis of this descriptive study alone. Important determinants such as type and toxicity of pesticide, storage practices, socioeconomic stressors, alcohol use, mental-health history, distance from health facilities and time to treatment were not measured. Suicide was the commonest manner of death, accounting for 76.9% of cases. This finding is consistent with the recognized role of pesticides as a means of intentional self-harm. The Million Death Study reported that poisoning was responsible for a substantial proportion of suicides in India and that many of these poisoning deaths involved pesticides [6]. Globally, pesticide self-poisoning has remained an important component of suicide mortality, especially in low- and middle-income countries [3]. An Indian review of pesticide regulation found that pesticide self-poisoning continues to be a major public-health problem and reported evidence that selected pesticide bans were followed by reductions in pesticide-suicide rates [12]. WHO therefore recommends restricting access to acutely toxic highly hazardous pesticides and strengthening pesticide regulation as population-level suicide-prevention measures [4,5]. In the present series, 35.3% of victims survived for 6-12 hours after poisoning and 33.3% were brought dead. These observations indicate that many fatal cases either died before reaching definitive care or deteriorated within the early hours following exposure. Because the study did not record precise time to first aid, referral delays, severity at admission, antidote administration, or intensive-care interventions, the influence of treatment delay on outcome cannot be quantified. Nevertheless, rapid transport, early resuscitation, poison identification where feasible and access to appropriate toxicological management remain important components of care for acute pesticide poisoning. In organophosphorus pesticide poisoning, established clinical guidance emphasizes early stabilization, appropriate antidotal therapy, ventilatory support when required and close monitoring for complications [13]. The public-health implications extend beyond clinical treatment. WHO and FAO guidance emphasizes regulatory identification and phase-out of highly hazardous pesticides, promotion of safer alternatives, appropriate packaging and labelling, safe storage, retailer and user education and surveillance of pesticide-related poisoning [2,5]. A systematic review of international evidence found that regulatory restrictions or bans on highly hazardous pesticides were generally followed by reductions in pesticide suicides and, in several settings, reductions in overall suicide mortality [14]. Such measures are particularly relevant in rural communities where pesticides may be stored in or near households and can become readily available during an acute suicidal crisis.

During the study period, 1,950 medico-legal autopsies were conducted. Of these, 250 (12.8%) were deaths due to poisoning and 156 were attributed to fatal pesticide poisoning. Thus, pesticide poisoning accounted for 62.4% of all poisoning deaths and 8.0% of all medico-legal autopsies. Among the 156 fatal pesticide poisoning cases, 129 (82.7%) were male and 27 (17.3%) were female, giving a male-to-female ratio of approximately 4.8:1. The largest age group was 20-29 years, comprising 134 (85.9%) cases (Table 1). With respect to occupation, 138 (88.5%) cases were engaged in agriculture and 18 (11.5%) were in non-agricultural occupations. Among agricultural cases, 129 (93.5%) were male and nine (6.5%) were female (Table 2). Most victims were residents of rural areas: 144 (92.3%) cases were rural and 12 (7.7%) were urban (Table 3). Based on the available clinical and medico-legal information, 120 (76.9%) deaths were suicidal, 30 (19.2%) were accidental and six (3.8%) were homicidal (Table 4). Regarding survival after poisoning, 55 (35.3%) victims survived for 6-12 hours, while 52 (33.3%) were brought dead. Twenty-six (16.7%) survived for 12-24 hours, 16 (10.3%) for 1-3 days and seven (4.5%) for 3-7 days (Table 5).

Table 1. Age- and sex-wise distribution of fatal pesticide poisoning cases

Note: Sex-specific percentages within each age group are row percentages; total-column percentages use 156 as the denominator.

Table 2. Sex and occupation-wise distribution of cases

Table 3. Sex and locality-wise distribution of cases

Table 4. Distribution according to manner of death

Table 5. Distribution according to period of survival

The present study describes the epidemiological pattern of 156 fatal pesticide poisoning cases examined at a tertiary medico-legal centre in Maharashtra. Pesticide poisoning accounted for 62.4% of all poisoning deaths and 8.0% of all medico-legal autopsies during the study period. These findings underline the continuing importance of pesticides in fatal poisoning in India. In a systematic review covering Indian studies from 1999 to 2018, Karunarathne et al. found pesticides to be the dominant class of poison reported in lethal poisoning, with organophosphorus insecticides remaining important across the country [7]. The present study did not contain sufficiently detailed toxicological data to compare specific pesticide classes and therefore conclusions regarding a particular compound should not be drawn from these data. A marked male predominance was observed: 82.7% of victims were male. The largest proportion of deaths occurred in the 20-29-year age group. Goswami et al., in a medico-legal autopsy study from north-eastern India, also reported male predominance and the highest proportion of acute poisoning deaths among young adults aged 21-30 years [8]. Nationally representative Indian data have similarly shown that suicide mortality is concentrated substantially in younger age groups [6]. The predominance of young adults in the present autopsy series is therefore epidemiologically plausible, although the very high proportion observed here may reflect local patterns, referral characteristics, or the case definition used. Agricultural workers represented 88.5% of cases and 92.3% of victims were from rural areas. This pattern is consistent with the occupational and geographic availability of pesticides in farming communities. The historical and contemporary literature has repeatedly highlighted the particular burden of pesticide exposure and self-poisoning in rural agricultural populations in South Asia [9]. Studies from the Sundarban region of India have documented pesticide self-poisoning among farming communities together with unsafe household storage and limited awareness of pesticide-related health risks [10,11]. However, occupation and rural residence should not be interpreted as causal factors on the basis of this descriptive study alone. Important determinants such as type and toxicity of pesticide, storage practices, socioeconomic stressors, alcohol use, mental-health history, distance from health facilities and time to treatment were not measured. Suicide was the commonest manner of death, accounting for 76.9% of cases. This finding is consistent with the recognized role of pesticides as a means of intentional self-harm. The Million Death Study reported that poisoning was responsible for a substantial proportion of suicides in India and that many of these poisoning deaths involved pesticides [6]. Globally, pesticide self-poisoning has remained an important component of suicide mortality, especially in low- and middle-income countries [3]. An Indian review of pesticide regulation found that pesticide self-poisoning continues to be a major public-health problem and reported evidence that selected pesticide bans were followed by reductions in pesticide-suicide rates [12]. WHO therefore recommends restricting access to acutely toxic highly hazardous pesticides and strengthening pesticide regulation as population-level suicide-prevention measures [4,5]. In the present series, 35.3% of victims survived for 6-12 hours after poisoning and 33.3% were brought dead. These observations indicate that many fatal cases either died before reaching definitive care or deteriorated within the early hours following exposure. Because the study did not record precise time to first aid, referral delays, severity at admission, antidote administration, or intensive-care interventions, the influence of treatment delay on outcome cannot be quantified. Nevertheless, rapid transport, early resuscitation, poison identification where feasible and access to appropriate toxicological management remain important components of care for acute pesticide poisoning. In organophosphorus pesticide poisoning, established clinical guidance emphasizes early stabilization, appropriate antidotal therapy, ventilatory support when required and close monitoring for complications [13]. The public-health implications extend beyond clinical treatment. WHO and FAO guidance emphasizes regulatory identification and phase-out of highly hazardous pesticides, promotion of safer alternatives, appropriate packaging and labelling, safe storage, retailer and user education and surveillance of pesticide-related poisoning [2,5]. A systematic review of international evidence found that regulatory restrictions or bans on highly hazardous pesticides were generally followed by reductions in pesticide suicides and, in several settings, reductions in overall suicide mortality [14]. Such measures are particularly relevant in rural communities where pesticides may be stored in or near households and can become readily available during an acute suicidal crisis.

Fatal pesticide poisoning in this autopsy-based study predominantly affected young adult males, agricultural workers and rural residents. Suicidal poisoning was the most frequent manner of death. The findings reinforce pesticide poisoning as an important medico-legal and public-health problem and support preventive measures that combine safer pesticide regulation and storage, community education, suicide-prevention strategies and timely access to emergency toxicology services. Because the study was descriptive and limited to fatal autopsy cases, the findings should not be extrapolated to all pesticide exposures in the community.

LIMITATIONS

This was a single-centre, autopsy-based descriptive study limited to fatal cases; therefore, it does not represent non-fatal pesticide poisoning in the community or hospital population. The analysis depended on the completeness of police inquest papers, clinical records and autopsy documentation. Specific pesticide compounds, toxicological confirmation, dose, route of exposure, mental-health history, alcohol use, socioeconomic factors, pre-hospital delay and detailed treatment variables were not studied. Consequently, causal associations and determinants of mortality could not be assessed.

CONFLICT OF INTEREST

None.

FUNDING

Nil