IntroductionOrganophosphorus 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.MethodsWith 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.ResultsAcute 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.DiscussionEthnographic 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.ConclusionsWhile 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
