Exposure to pesticides has been the source of many acute and chronic health problems in the rural population, mainly in developing countries. The objective of this study was to characterize the poisonings from acute exposure to agricultural pesticides used in the state of Mato Grosso do Sul, Brazil, from 1992 to 2002, which were reported to the Integrated Center of Toxicological Vigilance of the State Health Department. A total of 1355 involuntary (accidental or occupational) and voluntary (intentional self-poisoning) cases were reported during the period of the study. The majority of the poisonings occurred with men ranging in age from 15 to 49 years of age (55.1%). One hundred seventy-six poisonings lead to death, with a case fatality rate (CFR) three times higher than the average Brazilian CFR. The pesticide poisoning rates, per 100,000 inhabitants living in rural areas, ranged from 25 to 65.7 during the period of the study. In 2000, the micro-region of Campo Grande, where the state capital is located, had the highest rate, with 100.5 exposure/100,000 inhabitants, followed by Dourados, the larger agricultural region of the state. Insecticides were involved in 75.7% of the poisoning cases, followed by herbicides, with 12.2% of the cases. The anticholinestherase insecticides methamidophos, carbofuran and monochrotophos were the primary pesticides involved in the poisonings. The insecticide dimethoate was associated with the highest CFR (30.8%). The high rates of pesticide poisoning in the rural populations of certain regions of the state of Mato Grosso do Sul indicate the need for a more detailed study concerning the risk of pesticide poisoning among these populations.