"People are afraid of getting injections": feasibility of community-placed atropine auto-injectors in treating organophosphate poisoning in Sri Lanka.

INTRODUCTION

Organophosphorus insecticide poisoning remains a major problem in rural low- and middle-income communities. Atropine auto-injectors are used for organophosphorus nerve agent poisoning, but not organophosphorus insecticide poisoning. We explore the social and practical feasibility of introducing atropine auto-injectors in Sri Lankan villages to initiate first-line treatment for acute organophosphorus insecticide poisoning. We investigate how auto-injectors might be best integrated into the social and spatial context of rural communities with high levels of organophosphorus insecticide use and poisoning.

METHODS

With an ethnographic approach, we combined semi-structured interviews with community members (n = 18) and healthcare workers (n = 9), focus group discussions (n = 5), participatory mapping (n = 3), oral history interviews (n = 7), and ethnographic observations in three rural villages. A collaborative thematic data analysis was performed alongside continuous discussions within the global, interdisciplinary research team.

RESULTS

Acute organophosphorus insecticide poisoning was not perceived as a major public health concern that would demand an urgent intervention in communities. Following COVID-19 vaccination interventions, findings showed a lack of trust related to new medical injection technologies. Consequently, finding people to handle auto-injectors who had the capacity and willingness to take responsibility and were trusted by the community is a major challenge.

DISCUSSION: Ethnographic research methods are important and relevant in planning and implementing community health interventions. They contribute to making health interventions more effective and sustainable by analyzing context-dependent and often intractable complex health problems.

CONCLUSIONS

While our findings do not support introducing auto-injectors in the selected communities, it suggests placing them in the ambulances used to transport patients who have ingested pesticides. To further explore the need and feasibility of auto-injectors, similar situational, ethnographic analysis should be conducted in other parts of Sri Lanka and low- and middle-income countries with high numbers of acute organophosphorus insecticide poisoning and limited infrastructure facilities.