"Ad hoc policy decisions" in the news: Media framing analysis of a pesticide import ban in Sri Lanka.

Modern agriculture relies on pesticides to maximise outputs. While many highly hazardous pesticides (HHPs) are banned in places like the European Union due to concerns about harm to the environment and human health, their use continues in many low- and middle-income counties (LMICs). Pesticide suicide is a public health problem unique to countries where HHPs are used, and Sri Lanka has successfully implemented several HHP bans as part of a suicide prevention strategy. On 27 April 2021, the Sri Lankan government announced an imminent import ban of all fertilizers and pesticides which was later revoked in November 2021. The aim of this article was to explore the media framing of the import ban as it pertained to pesticides. Guided by Entman's typology of frame functions, we analysed newspaper articles from nine Sri Lankan newspapers (N = 102) between 20 April to 31 October 2021. Overall, most framings were supportive of the ban, captured by framings that articulated the ban through a health, environment, and organic farming narrative. Framings that foregrounded farmer or industry livelihoods and the pesticide market were primarily adopted to express opposition to the ban. The presence of frames opposing the ban within media articles increased over time during the study period. There was a greater proportion of opposing frames in private newspapers compared to government (78% vs 22%). Many of the articles analysed described the widespread impact of the ban, but only 11% of articles represented the voices of policy end users. This study adds understanding to the ways communication via outlets like mainstream newspapers may shape public support or opposition to pesticide bans in a LMIC. Mass media is an under-recognised factor in policy implementation and this study may inform planning to implement pesticide bans in other countries.

Exploring fidelity of enactment in a cluster randomised controlled trial testing the effectiveness of 'gatekeeper' training for pesticide vendors in reducing self-poisoning in rural Sri Lanka: protocol for a multimethod qualitative study.

INTRODUCTION: Pesticide self-poisoning causes severe health and socioeconomic hardship in low- and middle-income countries, including Sri Lanka. A stepped-wedge cluster randomised controlled trial (cRCT) has been designed to test whether 'gatekeeper' training for pesticide vendors reduces pesticide self-poisoning in rural Sri Lanka (Vendor cRCT). Ensuring intervention fidelity in RCTs is essential for consistently replicating interventions, accurately assessing their impact and improving outcomes. Thus, the overarching goal of this proposed study is to explore to what extent the pesticide vendors use the 'gatekeeper' strategies. METHODS AND ANALYSIS: A multimethod qualitative research design is being used to explore the pesticide-selling behaviours of vendors after the 'gatekeeper' training. A subsample of the Vendor cRCT Study population is being recruited using a stratified purposive sampling method in all six intervention districts in Sri Lanka to ensure that the sample is representative of the pesticide vendors in the study area. Participant diaries, observations and focus group discussions are being adopted to collect data. Data triangulation will be performed and data will be analysed thematically. ETHICS AND DISSEMINATION: The study was approved by the Ethics and Research Committee, Faculty of Medicine and Allied Sciences, at the Rajarata University of Sri Lanka (ERC/2023/09). All participants will provide informed consent. Findings will be disseminated in scientific peer-reviewed journals and conference presentations.

Gatekeeper training for vendors to reduce pesticide self-poisoning in rural South Asia: a study protocol for a stepped-wedge cluster randomised controlled trial.

INTRODUCTION: Pesticide self-poisoning kills an estimated 110 000-168 000 people worldwide annually. Data from South Asia indicate that in 15%-20% of attempted suicides and 30%-50% of completed suicides involving pesticides these are purchased shortly beforehand for this purpose. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such customers. We have developed a 'gatekeeper' training programme for vendors to enable them to identify individuals at high risk of self-poisoning (gatekeeper function) and prevent such individuals from accessing pesticides (means restriction). The primary aim of the study is to evaluate the effectiveness of the gatekeeper intervention in preventing pesticide self-poisoning in Sri Lanka. Other aims are to identify method substitution and to assess the cost and cost-effectiveness of the intervention. METHODS AND ANALYSIS: A stepped-wedge cluster randomised trial of a gatekeeper intervention is being conducted in rural Sri Lanka with a population of approximately 2.7 million. The gatekeeper intervention is being introduced into 70 administrative divisions in random order at each of 30 steps over a 40-month period. The primary outcome is the number of pesticide self-poisoning cases identified from surveillance of hospitals and police stations. Secondary outcomes include: number of self-poisoning cases using pesticides purchased within the previous 24 hours, total number of all forms of self-harm and suicides. Intervention effectiveness will be estimated by comparing outcome measures between the pretraining and post-training periods across the divisions in the study area. The original study protocol has been adapted as necessary in light of the impact of the COVID-19. ETHICS AND DISSEMINATION: The Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University, Sri Lanka (ERC/2018/30), and the ACCORD Medical Research Ethics Committee, Edinburgh University (18-HV-053) approved the study. Results will be disseminated in scientific peer-reviewed journals. TRIAL REGISTRATION NUMBER: SLCTR/2019/006, U1111-1220-8046.