Over 150,000 people die each year from pesticide poisoning. Most deaths result from self-poisoning by ingestion, rather than occupational or accidental exposures, which are typically topical or inhalational. Severe pesticide poisoning is more common in rural lower- and middle-income countries where pesticides are widely used in smallholder agricultural practice and therefore freely available. Significant acute poisoning is much less common in industrialized countries; here it is the long-term effects of low-dose chronic exposure that most concern the population.