Psychopathy and Sadism: A Systematic Review of Their Association, Core Dimensions, and Nosological Implications.

Pesticide poisoning remains a major global public health concern, particularly in low- and middle-income countries (LMICs) where agricultural production relies heavily on chemical pest control and regulatory oversight may be limited (). Globally, millions of pesticide poisoning cases occur annually, resulting in substantial morbidity and mortality among farming communities and rural populations (). The burden is disproportionately concentrated in LMICs, where highly hazardous pesticides (HHPs) remain widely available, safe-use practices are often inadequate, and poison surveillance systems are underdeveloped (). Pesticides contribute substantially to both occupational poisoning and intentional self-poisoning. Previous studies have demonstrated that a relatively small number of highly hazardous pesticides account for a disproportionate share of poisoning-related deaths worldwide (; ). Studies reported that pesticide self-poisoning remains a major contributor to mortality in rural agricultural communities (). Consequently, international organizations including the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) have advocated for progressive restriction and replacement of highly hazardous pesticides as a key strategy for reducing pesticide-related mortality (). Among highly hazardous pesticides, paraquat has consistently been identified as one of the most lethal compounds following acute poisoning (; ; ). Paraquat toxicity causes severe oxidative injury, particularly affecting the lungs, kidneys, liver, and cardiovascular system, frequently resulting in multi-organ failure and death despite medical treatment (; ; ). Organophosphate pesticides remain among the most commonly reported causes of pesticide poisoning globally because of their widespread agricultural use and their ability to induce cholinergic toxicity through inhibition of acetylcholinesterase activity (; ; ; ). Severe poisoning may lead to respiratory failure, seizures, cardiovascular complications, and death (; ). Although glyphosate is generally considered less acutely toxic than paraquat, severe poisoning following intentional ingestion of concentrated formulations has also been associated with significant morbidity and mortality (; ; ; ). In Tanzania, agricultural intensification and expansion of commercial crop production have been accompanied by increasing pesticide use (; ; ). Several studies have documented pesticide exposure and acute pesticide poisoning among farmers, agricultural workers, women, and adolescents in different parts of the country (; ). However, most available studies have focused primarily on exposure patterns, poisoning incidence, or demographic characteristics rather than pesticide-specific mortality and clinical outcomes. Consequently, evidence regarding the relative lethality of individual pesticide categories and their contribution to poisoning-related mortality remains limited. Recognizing the public health risks associated with highly hazardous pesticides, Tanzania has recently implemented regulatory actions through the Tanzania Plant Health and Pesticides Authority (TPHPA). These measures include withdrawal of pesticide products containing active ingredients classified as highly hazardous pesticides and removal of long-expired pesticide registrations from the market. Such interventions are consistent with global recommendations promoting restriction of highly hazardous pesticides as an effective means of reducing pesticide-related mortality and suicide deaths (; ). However, baseline evidence describing pesticide-specific mortality patterns remains essential for evaluating the effectiveness of these interventions and informing future regulatory decisions.