A five-year review of pesticide deaths in Pretoria, South Africa

Abstract

Pesticide poisoning remains a major global health concern, with low and middle-income countries like South Africa bearing a disproportionate burden. This retrospective, cross-sectional study analyzed 173 suspected pesticide poisoning deaths investigated at the Pretoria Medico-Legal Laboratory from January 2016 to December 2020. Most decedents were male (69.9%), with a mean age of 31 years; 85% were between 18 and 65. Foreign nationals comprised 12% of cases, and deaths peaked during winter (31% from June to August). Over half were referred from health care facilities, and 95% died within 24 hours of admission. Common autopsy findings included black, pepper-like granules in the gastrointestinal tract (89%), pulmonary froth (63%), and fecal soiling (14%). Toxicology was requested in 170 cases, but 86% remained pending; among 24 completed reports, 71% were positive for Terbufos. Pseudocholinesterase was measured in 39 cases, with levels reduced in 98% (mean = 1493 U/L). Histology most often showed intra-alveolar edema (83%) and pulmonary venous congestion (60%). The findings suggest that a combination of gross autopsy features, depressed pseudocholinesterase levels, and supportive histology may reliably indicate pesticide poisoning, even in the absence of timely toxicology results. The recent ban on Terbufos provides a key opportunity for future public health evaluation.