Characteristics of the households receiving storage boxes
More than three-quarters (318/400; 79.5%) of households included four or more persons. A similar proportion included children aged 0 to 18 years (281/400; 70.3%). In 36 (9.0%) of all the households included in the study at Time 1 the interviewee reported that a member of the household had been admitted to hospital after pesticide poisoning prior to commencement of study, 15 being reported as intentional and 21 as accidental. Six households reported that a member had died from pesticide poisoning, all with deliberate intent.
The land area (including garden) cultivated by the households was as follows: under 2 acres – 132 households (33.0%), 2–3 acres – 172 (43.0%), over 3 acres – 96 (24.0%). At the start of the study the predominant crops grown by the households showed marked variation between the households in the North Western Province and those in Southern Province, with rice and betel leaves being grown far more often by the households in the North West and peanuts, green grams and sesame being grown more often by households in the South. Livestock were farmed by 143 (35.8%) households, 94 (47.0%) in villages in the North West and 49 (24.6%) of those in the South. The most frequently farmed livestock were: cattle (114 households), chickens (32), pigs (8), buffalo (6) and goats (5).
At the Time 1 interview in only 7 out of 396 (1.8%) households were pesticides reported to be locked up. Easy accessibility to pesticides for adults was reported in 279/385 (72.5%) households, and for children in 195/387 (50.4%) households.
Dissatisfaction with current method of storage of pesticides was reported in nearly all households at the Time 1 interview (362/400, 90.5%). Analysis of the verbatim reasons given for lack of satisfaction with current method of storage show that the most frequent were fear of accidents or danger to life (34.0%), general lack of security (33.1%), risk of wastage or damage to pesticides (21.0%), and danger of suicide or non-fatal self-poisoning (18.2%).
Impact of introduction of storage boxes
The introduction of the boxes had a major impact on the subsequent storage of pesticides, with most informants at the Time 3 and Time 4 interviews reporting that pesticides were being stored in the box, and few reporting storage in other locations (Table
1). However, at the Time 4 interview more reported storing pesticides in a field than at Time 3.
Table 1
Storage of pesticides before and after the introduction of the boxes1
Box (locked away)
| (6) | (1.7%) | 357 | (98.6) | 343 | (96.6) |
Garden
| 185 | (51.5) | 2 | (0.6) | 3 | (0.8) |
Field
| 140 | (39.0) | 6 | (1.7) | 25 | (7.0) |
Separate building
| 71 | (19.8) | 2 | (0.6) | 1 | (0.3) |
House
| 68 | (19.0) | 6 | (1.7) | 6 | (1.7) |
On top of/under box
| | | | | 4 | (1.1) |
Other
| 3 | (0.9) | 2 | (0.6) | 2 | (0.6) |
At Times2, 3 and 4 informants in most households reported using the box all of the time (Time 2: 166/294, 56.5%; Time 3: 298/362, 82.3%; Time 4: 228/354, 64.4%) or most of the time (Time 2: 68/294, 23.1%; Time 3: 26/362, 7.2%; Time 4: 90/354, 25.4%). However, reported usage of the box in these and other households would have partly reflected the seasonality of pesticide use. At Time 4 only 7/354 (2.0%) of households reported that they never used the box. Reasons for never using the box included pesticides being hidden in the field (N = 3), fear of a family member attempting to gain access to the box and ingest the pesticides (N = 2), box fell down (N = 1) and not known (N = 1).
At the Time 2 and Time 3 interviews nearly all the informants reported that the box was always kept locked (Table
2). Inspection of the box at the time of the interviews showed that nearly all the boxes were locked. At the Time 4 interview, compared to Time 3, there was some reduction in the proportion of households reporting that the box was always kept locked (χ
2 = 26.13, df 3, p < 0.001), which was reflected in the reduced proportion locked on inspection (χ
2 = 52.04, p < 0.001) (Table
2). Reasons given at the Time 4 interview for not locking the box included: key lost or lock broken (N = 8), did not see the need to lock the box (N = 5), locking the box was a nuisance (N = 1), box was damaged (N = 1), and box not being used (N = 1) (not known – N = 3).
Table 2
Extent to which box locked according to informants and on inspection (Times 3 and 4)
Informants:
| | | | | | |
All of the time
| 270 | (91.8) | 336 | (92.8) | 267 | (75.2) |
Most of the time
| 16 | (5.4) | 10 | (2.8) | 32 | (14.6) |
Occasionally
| 3 | (1.0) | 8 | (2.2) | 17 | (4.8) |
Never
| 5 | (1.7) | 8 | (2.2) | 19 | (5.4) |
On inspection
| 276 | (93.9) | 339 | (93.6) | 262 | (73.8) |
Attitudes to box
Nearly all the informants at the Time 4 interview said that they thought that the box was useful (353/355, 99.4%) and safe (353/355, 99.4%). Just 4 (1.1%) said that the box was inconvenient.
Content analysis of the informants' comments on the advantages of the box at Time 3 and Time 4 indicated that the most frequent were the convenience for keeping pesticides, especially having them all in one place, general security of the pesticides, and avoiding wastage or damage to the pesticides (Table
3). At Time 4 somewhat fewer respondents commented on the convenience for storing pesticides, but more of the comments were about avoiding wastage/damage to pesticides, protection for children, protection against theft, avoiding easy or hurried access and saving money. While relatively few specifically highlighted protection against suicide or DSH, other responses such as avoiding easy or hurried access may have implied the same thing.
Table 3
Advantages of the box (based on comments at Time 3 and Time 4)1
Convenience/all in one place
| 178 | (49.3) | 123 | (34.6) |
General security
| 155 | (42.9) | 162 | (45.6) |
Avoids wastage/damage to pesticides
| 87 | (24.1) | 124 | (34.9) |
Protection for children
| 43 | (11.9) | 82 | (23.1) |
Protection against accidents/protects lives
| 32 | (8.9) | 39 | (11.0) |
Protection against theft
| 23 | (6.4) | 43 | (12.1) |
Cannot be accessed easily/in a hurry
| 11 | (3.0) | 40 | (11.3) |
Feelings of safety/relief
| 11 | (3.0) | 15 | (4.2) |
Saves money
| 8 | (2.2) | 26 | (7.3) |
Protection against suicide/DSH
| 6 | (1.7) | 12 | (3.4) |
Saves time
| 5 | (1.4) | 5 | (1.4) |
Protection for animals
| 2 | (0.6) | 6 | (1.7) |
Other
| 6 | (1.7) | 11 | (3.1) |
There were far fewer comments about possible problems with the use of the box. The main one was that the box was not big enough to store all the pesticides that might be used by the household, with substantially more informants saying this at the Time 4 interview (Table
4). Five householders reported at the Time 4 interview that the padlock had broken. Four thought that having the pesticides all in one place might make them more readily accessible to thieves and suicidal people.
Table 4
Problems with use of the box (Time 3 and Time 4)
Not big enough
| 22 | (6.1) | 54 | (15.2) |
Padlock broken
| | | 5 | (1.4) |
Pesticides in one place may increase risk
| | | 4 | (1.1) |
Inconvenient location
| 3 | (0.8) | 4 | (1.1) |
Hard to hide key
| 1 | (0.3) | 3 | (0.8) |
Unable to find key
| 1 | (0.3) | 3 | (0.8) |
Keyholder unavailable
| 1 | (0.3) | 1 | (0.3) |
When asked specifically at the Time 4 interview more than half the informants said that other villagers would like to have a box (209/344, 60.8%). However, only 5 (5/336, 1.5%) said that other villagers had made a box for themselves.
At the Time 4 interview five informants (5/355, 1.4%) reported attempted forced entry to the box. In two cases an individual who was apparently suicidal had tried unsuccessfully to force entry to the box (the informants commenting that the box may have saved the person's life), and in another case family members had to break into the box to get pesticides for urgent spraying because the farmer had gone out of the village and taken the key with him. Another case was reported by a family which was not using pesticides at the Time 4 interview – a household member had broken the box and swallowed pesticides, but recovered later in hospital.
Positive attitudes to the message on the box were indicated by most informants at the Time 3 (N = 352) and Time 4 (N = 338) interviews. Some examples were:
"Even when you are angry enough to drink poison seeing the message calms you down."
"Gives us a feeling that life is valuable."
"Very useful to see it constantly. Good to know that you can speak about your pain of mind to somebody."
"When you read it you know that there is poison in the box."
"It is useful. Visitors to the house too read it and gain by it."
"You gain more from the message than from the box."
At Time 4, 61 interviewees commented that the message had faded and was illegible. Also, at the Time 4 interview some respondents indicated that they would like the message or label to be changed in some way, including adding a visual representation of the message and using bigger letters.
When asked directly at the Time 3 interview nearly all the informants indicated that the boxes might have positive benefits in terms of prevention of both accidents (357/362, 98.6%) and suicide (344/362, 95%). Some examples of comments made by informants about possible benefits and negative effects in terms of prevention of accidents were:
Positive effects (98.6%)
"When the pesticides are not just left around there will be no room for accidents."
"Because the box is locked accidents are less."
"Accidents have reduced in the whole village. I am not afraid now of the safety of our children."
"Accidents are avoided because the pesticides no more get mixed with food."
"Because it's installed high, less chance of taking the poison accidentally."
"If the person holding the key is careful with it accidents can be avoided."
Negative effects (0.9%)
"Box is of no use"
"Can get the pesticides elsewhere"
"He feels the protection is for the pesticides and not the people"
Examples of possible positive and negatives effects of the boxes in terms of prevention of suicide were:
Positive effects (95.0%)
"Although we are surrounded by many problems we do not fear suicide as the box is locked."
"Because of the delay in getting the keys suicides are prevented."
"Because the box is locked I have no fear now. I attempted suicide before."
"Unable to take poisons in a state of anger."
"Because they are unable to open the box quickly their anger subsides."
Negative/no effects (3.3%)
"Person can take yellow oleander even if the pesticides are locked."
"If the man who has the key gets angry he can always access the poisons."
"If a person is bent on suicide they can always use a different method or even break the lock."
"If there is no key, taking the poisons to commit suicide will be easy because all the poisons are available in one place."
"If a person wants to commit suicide they can always purchase the poisons from the shop. So it is necessary to do awareness programs."
The negative comments indicated awareness of possible substitution of another method for suicide, and ways of getting access to the pesticides. However, most respondents thought the boxes would have a positive effect in terms of suicide prevention.