Accidental deaths: Products readily available in local shops are bought to deal with problems such as rats. (Delwyn Verasamy/M&G)
Last month, Cindy Stephen received a call on the Poisons Information Centre helpline from a concerned doctor at a hospital in Mpumalanga. His patient was gravely ill.
“He had intentionally drunk some weed killer about four days prior. He had a period of severe stress,” said Stephen, the director of the centre at the Red Cross War Memorial Children’s Hospital in Cape Town.
“He was treated at the clinic and he was discharged a day or two later, being well.”
Two days later, the man was back in hospital. “He was struggling to breathe, even with oxygen. His eyes were yellow, his liver had failed, he had kidney damage and severe ulcers in his mouth,” Stephen said.
The weed killer was in an unmarked container, but the symptoms were classic of paraquat, a highly hazardous pesticide banned in 50 countries, but widely used in South Africa to control weeds. There are few treatment options and death is almost inevitable.
“It’s tragic. There is absolutely no way that such a toxic chemical should be available to anybody, let alone as easily as this man could obviously access it,” Stephen said.
She was making a presentation on the health effects of agropesticide exposure at a national colloquium hosted by the department of agriculture.
Stephen presented data collected since 2015 from the Poisons Information Centre helpline, Tygerberg Hospital’s Poison Information Centre and the national notifiable medical condition system.
The helpline receives more than 13 000 calls a year from across South Africa, mostly from doctors. The database now has more than 132 000 case records.
“We obviously deal with exposures and poisonings to many substances and pesticides account for about 12%,” Stephen said.
Cases of pesticide poisoning have steadily increased since 2015. “For the last three or four years, we’ve been seeing a minimum — and remember this is undoubtedly under-reported — of over 1 000 cases per year.”
From 2015 to 2025, 24% of reported cases involved unknown pesticides, which were illegal and sold in unmarked containers, Stephen said.
“That will include a lot of so-called street pesticides and these are products that are either unregistered and brought into the country illegally, or they are registered products, which have been decanted into unmarked packaging and containers. We know this is a very common and wide-spread practice.”
Although most patients have few or minor symptoms, 15% suffer severe morbidity or illness.
“We have over 2 000 such cases in our data. In the last 10 years, we’ve also recorded 35 deaths,” said Stephen.
The notifiable medical condition data paints a grim picture, recording about 530 pesticide-related deaths in the past eight to nine years.
“Agricultural and stock remedy poisoning was recently made a category one notifiable medical condition, as it should be,” she said. “It’s deeply concerning when we start looking at their data.”
The proportion of patients who die is high. For pharmaceuticals like paracetamol, it’s about 0.5%, meaning one in 200 patients will die. Globally, pesticides are about 6-7%, which Stephen noted is expected because these are poisonous substances.
In South Africa, the June 2025 data from the notifiable medical conditions was 91 reported pesticide poisoning cases. Nineteen of these died.
“That’s a case fatality rate of 20%,” Stephen said. “This is a really alarming statistic and shows the serious human health impacts of highly hazardous pesticides.”
By contrast, despite many malaria and measles cases, there was only one death from malaria in June.
The groups vulnerable to poisoning are children under five, making up 17% of all symptomatic cases, mostly through accidental exposure. And 16% of cases are among those aged 10 to 19.
Stephen said 86% of these poisonings are due to self-harm and 70% involve girls. Young adults aged 20-35 account for 36% of cases.
Globally, more than 700 000 people died of suicide in 2019. Suicide is the fourth-leading cause of death among 15-to-29-year-olds, and the third-leading cause of death among 15-to-19-year-old girls.
In 2014, a continent-wide study found hangings and pesticides are the most common suicide methods. “In South Africa, children as young as 10 or 11 are accessing pesticides for self-harming behaviour,” she said. “Two-thirds of pesticide poisonings in adults are also due to intentional self-harm.”
Stephen spoke about a case that underscored the deadly consequences of weak regulation, telling how a family living in a township had welcomed a new baby.
“They had a four-week-old baby in their home and one weekend the mother and four children all presented at the local hospital with what we thought was gastro.” The family was generally stable and treated accordingly. But suddenly the newborn baby’s condition deteriorated.
“The baby suddenly collapsed. She developed fluid on her lungs, she needed ventilation. Her blood pressure dropped precipitously … but tragically and unexpectedly, she passed away.”
The environmental health practitioner investigated and discovered the father had bought QuickPhos at the local hardware store and put it under the beds to kill the rats.
“QuickPhos is an aluminium phosphide and it combines with water in the air and produces this very, very toxic phosphine gas and it is that which caused the death of this baby,” Stephen said.
This was a clear regulatory failure. “Aluminium phosphide should only be sold to registered pest control operators.”
On the opportunities for intervention, Stephen cited a study in Sri Lanka over a 20-year span, where various highly hazardous pesticides were phased out. “They monitored a 70% reduction in suicide deaths during that time and in this period there was also no change in food security. So, it is possible.
“We obviously need updated policy and regulations that can be enforced,” she said, adding that surveillance should also be strengthened.