Abstract: Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria. For educational interventions aiming at reducing injury rates among adults the pooled rate ratio after recalculation from effect sizes in three RCTs was 1.02 (95% CI 0.87 to 1.20). For educational interventions aiming at children the pooled rate ratio for injury rates in two RCTs was 1.27 (95% CI 0.51 to 3.16).   One ITS study that evaluated the effect of an intervention that included financial incentives decreased the injury level immediately after the intervention with an effect size of -2.68 (95% CI -3.80 to -1.56) but did not have a significant effect on the injury trend over time with an effect size of -0.22 (95% CI -0.47 to 0.03).   One ITS study that evaluated the effect of legislation to ban Endosulfan pesticide on fatal pesticide poisonings increased the level of poisonings immediately after the introduction with an effect size of 2.20 (95% CI 0.97 to 3.43) but led to decrease in the trend of poisonings over time with an effect size of -2.15 (95% CI -2.64 to -1.66).   One ITS study documented four different regulations aiming to increase the use of rollover protective structures (ROPS) on tractors and their effect on injuries and fatal injuries. The introduction of two different pieces of legislation requiring ROPS on new tractors sold after a certain date was associated with a decrease of fatal injuries over the long term (effect size -0.93 95% CI -1.82 to -0.03). Otherwise the introduction of legislation was associated with an increase of injury rates. Introduction of legislation requiring ROPS on all tractors, old tractors included, was not associated with a decrease but with an increase of injuries and fatal injuries over the long term. The selected studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives could reduce injury rates. Legislation to ban pesticides could be effective. Legislation expanding the use of safety devices (ROPS) on new tractors was associated with a decrease in fatal injuries.

Plain-language summary: A systematic literature search was conducted to find studies on interventions to reduce occupational injuries in agriculture. Eight studies were found from over 8600 references. The quality of the relevant studies was assessed and their results extracted. Randomised controlled trial data were combined across studies in a meta-analysis. Interrupted time series studies were reanalysed to assess if there was a change in the level or trend of injuries associated with the intervention. Five randomised controlled trials with 11,565 participants and one interrupted time series study with 14 measurement points used combinations of various educational interventions and financial incentives. Two of these studies concentrated on injury prevention among children or adolescents and the rest dealt with injury prevention among adults. The effect of legislation was evaluated in two interrupted time series studies with on average 32.5 measurement points. One study evaluated regulations to prevent tractor rollover injuries in Sweden and another study evaluated regulation to reduce fatal pesticide poisonings in Sri Lanka. The methodological quality was rated as less than high for all included studies. The studies provided no evidence that the educational interventions had an injury reducing effect. However, insurance premium discounts as a financial incentive decreased injuries claims in one study. Specific legislative mandates expanding the use of Rollover Protective Structures (ROPS) on tractors were not associated with a reduction of injuries in one study. Legislation to ban Endosulfan pesticides was associated with a reduction in fatal poisonings in the long term in another study.