Reducing the incidence of acute pesticide poisoning by educating farmers on integrated pest management in South India

Comprehensive Clinical Assessment of Patients With Acute Organophosphorus Poisoning in a Tertiary Care Hospital

Background The use of organophosphorus (OP) compounds as pesticides is widespread, particularly in developing nations such as India. These substances are easily accessible and often linked to suicide poisoning incidents, especially among distressed farmers. In India, OP poisoning remains a significant cause of emergency hospital admissions. This study aims to analyze the clinical profile of patients admitted with OP poisoning, focusing on the various clinically significant characteristics and aspects associated with these cases. Methods Throughout the course of two years (from June 2022 to May 2024), five hospitals with critical care units participated in this prospective observational study. These hospitals referred patients to the Prathima Institute of Medical Sciences, which served as the central facility for the study. The study focused on individuals who arrived at the emergency room within 24 hours of acute exposure to organophosphate pesticides. A total of 150 patients meeting the inclusion criteria were enrolled. Data collection included a comprehensive clinical examination, detailed patient history, and monitoring of the response to intravenous atropine. The severity of the poisoning was evaluated using the Peradeniya Organophosphorus Poisoning (POP) scale, adapted for this study. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York), with descriptive statistics used to summarize the categorical and continuous variables. Results The results of the study demonstrated a notable relationship between the arrival time at the health facility and mortality rates among patients with OP poisoning. Patients who arrived within three hours had a mortality rate of 13.2% (five out of 38 cases), while those arriving between three and six hours had a slightly higher rate of 14.3% (10 out of 70 cases). The mortality rate sharply increased to 28.6% (12 out of 42 cases) for patients who arrived after six hours. Among the OP compounds, monocrotophos showed the highest mortality rate at 80% (eight out of 10 cases), followed by dimethoate with 42.9% (12 out of 28 cases) and dichlorvos with 62.5% (five out of eight cases). The overall mortality rate in the study was 22.7% (34 out of 150 cases). Conclusions Poisoning with OP has primarily impacted young, productive men. Considerable mortality results from a disease condition that is more severe at presentation. It is advised to selectively outlaw the riskier substances that account for a larger percentage of fatalities.

Pesticide Poisoning Among Children in India: The Need for an Urgent Solution

Pesticides have been increasingly recognized as a significant source of morbidity and mortality, especially in the developing world. In particular, significant attention has been given to the use of pesticides to cause deliberate self-harm in India. Approximately half of suicides in India are due to intentional poisoning of which the majority are from pesticides. Young children are commonly poisoned by accidental ingestion, unintentional dermal or inhalational exposure, whereas adolescents are more severely poisoned if attempting self-harm through intentional ingestion. It is the purpose of this paper to highlight the problem of pesticide poisoning in the pediatric population of India, and to recommend policy options to address this global problem. Reducing access to pesticides and educating farmers and the public regarding the proper storage and use of pesticides and the establishment of more poison centers in India can be part of a broader strategy to address these life-threatening poisonings in children.

The effectiveness of educational interventions aimed at agricultural workers' knowledge, behaviour, and risk perception for reducing the risk of pesticide exposure: a systematic review and meta-analysis

AIM

The aim of this study was to determine the effectiveness of educational interventions aimed at agricultural workers' knowledge, behaviour, and risk perception for reducing the risk of pesticide exposure.

METHOD

All studies published in the English language between the years 2000 and 2020 were screened on relevant databases. The study protocol was registered on PROSPERO. Randomised controlled studies (RCTs) and quasi-experimental studies meeting the inclusion and exclusion criteria according to the PICOS criteria were included. In line with the PRISMA flow diagram, 38 studies were included in the systematic review and meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias assessment tool. A random-effects model was applied and Hedge's g was used to calculate effect size.

FINDINGS

Five of the included studies are RCTs, two are cluster RCTs, 17 are quasi-experimental studies with experimental and control groups, and 14 have single-group pretest-posttest study designs. Educational interventions had a large effect on knowledge level (Hedge's g = 0.890), a medium effect on behaviour level (Hedge's g = 0.707), and a small effect on risk perception (Hedge's g = 0.377). No publication bias was detected. The largest effect of educational interventions on both knowledge and behaviour levels belonged to studies grounded on a theoretical basis and carried out between the years 2011 and 2020.

CONCLUSION

It was determined that educational interventions are an appropriate method for reducing the pesticide exposure risks of agricultural workers. To increase the effectiveness of these interventions, it is recommended that consideration is given to a theoretical basis, the use of multiple education components, and evidence-based practices.

Suicide in Spanish Farmers in Two Geographical Areas with Differing Rates of Pesticide Use

This study assesses whether farmers' suicides were associated with the pesticide use in Spain. The cohort study followed 9.5 million men aged 20-64 years who were employed in 2001. The mortality among farmers and non-farmers during the period 2001-2011 was estimated in a geographical area with high pesticide use and in an area with low pesticide use. For three major causes of death (suicide, unintentional accidents, and rest of causes of death), we estimated the age-standardized mortality rates with 95% confidence intervals (CI) between farmers and non-farmers in both areas. Farmers in the high pesticide use area showed a lower mortality rate of suicide and unintentional accidents than farmers in the rest of Spain, with mortality rate ratios of 0.74 (95% CI 0.65-0.85) and 0.57 (95% CI 0.52-0.62), respectively. Our findings on pesticide use and farmers' suicide are different from those observed in several previous investigations.

Conservation Agriculture and Integrated Pest Management Practices Improve Yield and Income while Reducing Labor, Pests, Diseases and Chemical Pesticide Use in Smallholder Vegetable Farms in Nepal

Improving smallholder vegetable farms are critical for improving food security and livelihoods of people in low-income countries. Vegetable production is labor intensive and prone to pests and diseases. Conservation agriculture (CA) and integrated pest management (IPM) practices provide options to increase yields and minimize the use of chemical pesticides. We compared integration of CA and IPM practices (improved alternative system) with farmers’ traditional practice (conventional system) under replicated on-farm tests in four different locations (Lalitpur, Banke, Surkhet, and Dadeldhura) in Nepal. Data on yield, benefit–cost ratio (B:C), labor requirement, insect and disease infestation, and pesticide sprays on five major vegetable crops (tomato, cucumber, bitter gourd, cabbage, cauliflower) were measured. In tomatoes, cucumbers, and bitter gourds, the improved alternative system produced a significantly higher yield, greater benefit-cost ratio, reduced labor, decreased the infestation of pests and diseases, and required fewer pesticidal sprays. Average yield and net income were superior in cabbages and cauliflowers, but nonsignificant. Improved alternative system for all the vegetables were sprayed significantly fewer times than the conventional system. Overall, the improved alternative system for vegetable crops contributed not only to the improved income and livelihoods of people, but also can improve environment and human health due to the reduced use of pesticides. Further research on scaling these improved alternative practices through appropriate farmer organizations, and government and non-government actors can enhance the adoption of CA and IPM practices by smallholder vegetable producers.

Impacts of farmer field schools in the human, social, natural and financial domain: a qualitative review

The Farmer Field School (FFS) is a widely used method seeking to educate farmers to adapt agricultural decisions to diverse and variable field conditions. Out of 218 screened studies, 65 were selected to review the impact of the FFS. An analytical framework was developed with effects (outputs, outcomes and impacts) arranged according to the human, social, natural and financial domains. Impacts on non-participants of the FFS were addressed as peripheral effects. The FFS demonstrated its potential to enhance human, social, natural and financial capital of rural communities. Human capital was built in the form of critical thinking, innovation, confidence, and quality of life. Effects on social capital included mutual trust, bonding, collective action, networking, and emancipation. Natural capital was enhanced through improvements in field practices, food production, agricultural diversification, and food security. Financial capital was enhanced through increased income and profits, savings and loans schemes, with a potential to reduce poverty. The available body of evidence was unbalanced across the capital domains, providing high coverage of the natural domain but low coverage of the human, social and financial domains. In-depth case studies are needed to elucidate the interactions between livelihood assets, and the influences of the policy, institutional and external environment, in order to adjust FFS interventions aiming to optimize their impacts. Considering the positive effects the FFS can have on rural livelihoods, the FFS has potential to contribute to achieving the Sustainable Development Goals. However, quality assurance of the FFS and a balanced evaluation across the capital domains require attention.

Educational Interventions to Improve Safety and Health Literacy Among Agricultural Workers: A Systematic Review

Health and safety education for farmers has the potential to increase the level of health, safety literacy, and thereby improve farmers’ health and quality of life. The aim of this paper is to provide a systematic review of the published literature documenting different educational interventions for agricultural workers that have the improvement of health and/or safety literacy as an outcome. A systematic search was conducted in PubMed, Embase, Scopus and PsycINFO databases for articles focusing on educational interventions for farmers’ health and safety. From the 3357 initial hits, 36 unduplicated records met the inclusion criteria. The articles included in the review used educational interventions for farmers with the purpose of preventing farm-induced diseases and injuries, increasing the health and well-being of farmers, and promoting good manufacturing practices. The educational approaches considered varied from lectures, videos, newsletters, games, and community fairs, to involving the community in designing the intervention and training farmers to deliver the intervention to the community. Interventions that used evidence-based theories, which took into account cultural aspects and individual factors, used biomarkers as a behavior change measurement, and involved the community in the development of the intervention had the best results in terms of behavior change. The strategies of educational interventions identified in this review that produced good results have the potential to inform future researchers and policy makers in the design and implementation of public health interventions, programs and policies to improve the health of farmers and their families.

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists.

[Clinical features of acute poisoning in hospitalized children: an analysis of 586 cases]

OBJECTIVE

To investigate the clinical features of acute poisoning in hospitalized children.

METHODS

A retrospective analysis was performed on the clinical data of 586 hospitalized children who were diagnosed with poisoning and discharged from the Children's Hospital of Chongqing Medical University between January 2006 and December 2015.

RESULTS

The patients included 354 males and 232 females (age: 24 days to 15.8 years). Of the 586 cases, 450 (76.8%) were infants and preschool children; 463 (79.0%) came from rural areas; 551 (94.0%) were hospitalized because of unintentional poisoning. The drug poisoning, pesticide poisoning, and rodenticide poisoning accounted for 221 cases (37.7%), 167 cases (28.5%), and 175 cases (29.9%) respectively. There was a significant difference in the distribution of the poisoning toxins between urban and rural children (P<0.01), and drugs and pesticides were the most common toxins for urban and rural children respectively. There were significant differences in main clinical manifestations between the children with drug poisoning, pesticide poisoning, and rodenticide poisoning (P<0.01), who presented with main clinical symptoms of the nervous system, digestive system, and circulatory system respectively. There was no significant difference in overall response rate between the children poisoned by different toxins.

CONCLUSIONS

Acute poisoning is most common in infants and preschool children. The majority of the patients are from rural areas. The majority of acute poisoning is unintentional. Poisoning by drugs is the main type of acute poisoning. There is no significant difference in overall response rate between the children poisoned by different toxins, but their clinical manifestations are different.

Changes in Perceptions and Practices of Farmers and Pesticide Retailers on Safer Pesticide Use and Alternatives: Impacts of a Community Intervention in Chitwan, Nepal

Unsafe use of hazardous pesticides is a neglected public health problem in developing countries. This survey evaluates the effects of a training program to increase awareness on harmful effects of pesticides and to enhance capacity for safe handling involving 57 trained farmers, 98 neighboring farmers, 94 control farmers, and 23 pesticide retailers from villages in Chitwan, Nepal. Knowledge and attitude-related variables improved in all 3 farmer groups, with a significant trend of better knowledge and attitude from trained to neighboring to control farmers (in 14/16 [87.5%] variables). In practice, there were significant differences among the groups with a trend from trained to neighboring to control farmers (in 10/26 [38.5%] variables).The pesticide retailers also improved on knowledge and practice. In conclusion, training farmers and pesticide retailers improved their knowledge and practice, with possible positive effect on neighboring farmers and control villages as well. An improved extension service to farmers is recommended.

Effect of Integrated Pest Management Training on Ugandan Small-Scale Farmers

Small-scale farmers in developing countries use hazardous pesticides taking few or no safety measures. Farmer field schools (FFSs) teaching integrated pest management (IPM) have been shown to reduce pesticide use among trained farmers. This cross-sectional study compares pesticide-related knowledge, attitude, practice (KAP), potential exposure, and self-reported poisoning symptoms among 35 FFS farmers, 44 neighboring farmers, and 35 control farmers after an IPM intervention in Uganda (2011-2012). The FFS farmers were encouraged to teach their neighboring farmers. Data were based on standardized interviews and were analyzed using a linear trend test and logistic regression. The results showed that FFS and neighboring farmers used significantly fewer pesticide applications (P = .021) and used more safety measures. No differences were found on the hazardousness of pesticides used or self-reported symptoms. The study supports IPM as a method to reduce pesticide use and potential exposure and to improve pesticide-related KAP among small-scale farmers in developing countries.

Association of Long-Term Pesticide Exposure and Biologic Parameters in Female Farm Workers in Tanzania: A Cross Sectional Study

The study aimed to assess the association of long-term pesticide exposure (≥5 years) with hematological, serum biochemical parameters and acetylcholinesterase activity in farm workers. These pesticides included organophosphorus pesticides, carbamates, pyrethroids, dithiocarbamates, and other pesticides such as endosulfan. Applying a cross-sectional study design, 69 females from a pesticide-exposed farm population and 30 females from a district not using pesticides (reference group) were studied. The mean red cell corpuscular volume and hematocrit values were significantly lower (74.7 ± 9.1 fl; 95% CI 72.5-76.9 and 32.0% ± 4.6%; 95% CI 30.9-33.1, respectively) in the exposed compared to the reference group, whereas mean corpuscular hemoglobin concentration and platelets were significantly higher (37.4 ± 3.8 g/dL; 95% CI 36.5-38.3 and 374.1 ± 95.3/L; 95% CI 351.2-396.9, respectively) in the exposed compared to the reference group. Mean serum glutamic oxaloacetate transaminase (20.7 ± 8.9 U/L; 95% CI 18.5-22.9) and creatinine (83.9 ± 6.6 μmol/L; 95% CI 82.3-85.5) were significantly higher in the exposed compared to the reference group. A higher mean esterase activity (AChE 0.6 ± 0.2 mM/min/mg protein; 95% CI 0.56-0.7; BChE 0.9 ± 0.4 mM/min/mg protein; 95% CI 0.9-1.1) was noted in the exposed group. Regression models suggest that occupational exposure (p < 0.001) could be a predictor of esterase (AChE and BChE) activity and biochemical changes (β = 0.4, 95% CI: 0.3-0.5; β = 0.7, 95% CI: 0.6-0.9, respectively). Long-term pesticide exposure affects the hemato-biochemical and esterase responses, establishing the need for further studies.

Organisational participation and health among smallholder farmers: a longitudinal study in a Latin American context

OBJECTIVE

To understand the impact of social organisation affiliation and farmers' agricultural production practices on farmer health. Organisations facilitate the acquisition and exchange of forms of social capital which can influence the adoption of practices with potential health impacts. In countries such as Ecuador, smallholder agriculture is practised by socially vulnerable populations. Agricultural production often involves the use of extremely hazardous pesticides, while practices that reduce the use of chemicals through integrated pest management (IPM) remain uncommon.

DESIGN

Longitudinal study (2007-2010).

SETTING

12 Ecuadorian communities, previously part of a participatory action research study.

PARTICIPANTS

208 small-scale farmers. Inclusion criteria were: age between 18 and 65 years, literate and resident in the community for the previous 3 years.

PRIMARY OUTCOMES

The differential effects of the membership in social organisations (as an effect modifier), on the relationship between the implementation of IPM practices (main independent variable) and farmers' health, measured by neurocognitive performance scores (better higher value; dependent variable).

RESULTS

Among organisational participants, the coefficient of association between the implementation of IPM practices for the category good/very good (vs no use) and neurocognitive performance, when farmers were involved in organisations, was negative and moderate (β=-0.17, SE 0.21) though not significant (p>0.1); for the category little/moderate use, the coefficient was positive (β=0.34, SE 0.19) and significant. Among those who did not participate in organisations, both little/moderate use and good/very good use of IPM practices were associated with an increase in neurocognitive performance.

CONCLUSIONS

The effect of agricultural production practices on farmers' health, transmitted through organisations, can be differentiated. Organisations as structures of social capital seem to be functional in the social reproduction process of the communities studied. Results highlight the need to redirect the analysis of social capital to a more integrated study of social determination of health.

Do Bolivian small holder farmers improve and retain knowledge to reduce occupational pesticide poisonings after training on Integrated Pest Management?

BACKGROUND

Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide poisonings and pollution of the environment. This survey evaluates the training of small holder farmers on pesticide handling and ecological alternatives to reduce the negative pesticide effects.

METHOD

A baseline survey was performed in 2002 and follow-up surveys in 2004 and 2009. Farmers were selected and trained on Integrated Pest Management (IPM) from 2002 to 2004 in Farmer Field Schools (FFS). After exclusions and drop outs, 23 FFS trained farmers could be compared to 47 neighbor farmers for changes in 'knowledge, attitude and practice' (KAP) on IPM and symptoms of poisoning when handling pesticides. Statistical analysis was performed with SPSS version 21.0 using χ2-test, Cochran's Q test and Student's T-test.

RESULTS

Improvements were seen in both groups but most significant among the FFS farmers. At baseline no difference were seen between the two groups apart from a more frequent use of personal protection among the FFS farmers. After the training was finished significant differences were seen between FFS farmers and neighbor farmers on all KAP variables, a difference reduced to six of the KAP variables in 2009. No difference was seen in self-reported poisonings after pesticide handling. FFS farmers improved their KAP scores markedly during training and there after retained their knowledge, while neighbor farmers improved during the entire period. Ecological farming without the use of pesticides increased most among the FFS farmers.

CONCLUSION

The study showed a sustained improvement among Farmers Field School trained farmers on personal protection and hygiene when handling pesticides, knowledge and use of IPM and ecological alternatives and a reduction in self-reported symptoms after pesticide handling. Similar though less pronounced improvements was seen among neighbor farmers having had less training and information on pesticide handling and alternatives than the FFS trained farmers. Training of farmers on IPM and good agricultural practices has positive effects, but is scarce in Bolivia as in most low-income countries and must be encouraged to support an improved and sustainable food production and to protect the health of farmers and consumers as well as the environment.

Occupational pesticide exposures and respiratory health

Pesticides have been widely used to control pest and pest-related diseases in agriculture, fishery, forestry and the food industry. In this review, we identify a number of respiratory symptoms and diseases that have been associated with occupational pesticide exposures. Impaired lung function has also been observed among people occupationally exposed to pesticides. There was strong evidence for an association between occupational pesticide exposure and asthma, especially in agricultural occupations. In addition, we found suggestive evidence for a link between occupational pesticide exposure and chronic bronchitis or COPD. There was inconclusive evidence for the association between occupational pesticide exposure and lung cancer. Better control of pesticide uses and enforcement of safety behaviors, such as using personal protection equipment (PPE) in the workplace, are critical for reducing the risk of developing pesticide-related symptoms and diseases. Educational training programs focusing on basic safety precautions and proper uses of personal protection equipment (PPE) are possible interventions that could be used to control the respiratory diseases associated with pesticide exposure in occupational setting.

Pesticide poisoning in Zhejiang, China: a retrospective analysis of adult cases registration by occupational disease surveillance and reporting systems from 2006 to 2010

OBJECTIVE

Despite the rapid industrialisation and urbanisation over the past 30 years, agriculture is one of the largest economic sectors in China and the unregulated use of pesticides result in extensive pesticide poisoning. The objective of this study was to analyse pesticide poisoning cases registration received by Zhejiang Provincial Center for Disease Control and Prevention, China.

DESIGN

Register-based study.

SETTING

Cases registered regarding pesticide poisoning. Data were obtained from the Occupational Disease Surveillance and Reporting Systems in Zhejiang province from 2006 to 2010, which contains anonymous records representing general population of Zhejiang province, China.

PARTICIPANTS

All cases registered as pesticide poisoning were identified.

PRIMARY OUTCOME

Monthly and age-group pesticide poisoning death rates were calculated.

RESULTS

A total of 20 097 pesticide poisoning cases with 1413 deaths were recorded during the study period. There were 10 513 male pesticide poisoning cases with 782 deaths, and 9584 females with 631 deaths. Pesticide poisoning occurred mostly in non-occupational exposure (79.86%), in which the majority (85.77%) of the cases was of intentional pesticide poisoning. The occupational exposure was most common in men during the farming season. The death rate increased stepwise with age, and the pesticide suicide rate was higher in the older age group.

CONCLUSIONS

Pesticide poisoning remains a major health problem in China, and further recommendations to reduce the pesticide poisoning are required.

Emerging health risks associated with modern agriculture practices: a comprehensive study in India

In order to enhance food production, India has adopted modern agriculture practices and achieved noteworthy success. This achievement was essentially the result of a paradigm shift in agriculture that included high inputs of agrochemicals, water, and widespread practice of monoculture, as well as bureaucratic changes that promoted these changes. There are very few comprehensive analyses of potential adverse health outcomes that may be related to these changes. The objective of this study is to identify health risks associated with modern agricultural practices in the southern Indian state of Karnataka. This study aims to compare high-input and low-input agricultural practices and the consequences for health of people in these communities. The fieldwork was conducted from May to August, 2009 and included a survey carried out in six villages. Data were collected by in-depth personal interviews among 240 households and key informants, field observations, laboratory analyses, and data from secondary sources. The study identified four major visible impacts: occupational hazards, vector borne diseases, changing nutritional status, and inequity in development. In the high-input area, mechanization has resulted in more occurrences of serious accidents and injuries. Ecological changes due to rice cultivation in this area have further augmented mosquito breeding, and there has been a surge in the incidence of Japanese encephalitis and malaria. The traditional coarse cereals (complex carbohydrates, high protein) have been replaced by mill-polished rice (simple carbohydrate, low protein). The prevalence of overweight (BMI>25) has emerged as a new public health challenge, and this is most evident in large-landholding households, especially in the high-input agriculture areas. In all agro-ecological areas, it was observed that women faced a greater risk of both extremes of under-nutrition and being overweight. Output-driven and market-oriented modern agricultural practices have changed the ecology and disease pattern in this area in India, and our survey indicated significant health effects associated with these changes. There is a need for more extensive epidemiological studies in order to know the full impact on diseases and to understand the complex causal relationships.

Pesticide poisonings in South Korea: findings from the National Hospital Discharge Survey 2004-2006

OBJECTIVES

Pesticide poisoning stands as a major public health issue worldwide. The objective of this study was to examine the epidemiologic characteristics of pesticide-related hospitalizations in South Korea.

METHODS

Data from the Korea National Hospital Discharge Survey were analyzed to describe the epidemiologic characteristics of pesticide poisoning among hospitalized patients from 2004 through 2006. Pesticide-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision codes. National estimates of pesticide-related hospitalizations were calculated using sampling weights for number of hospitalizations.

RESULTS

A total of 25,982 pesticide-related hospitalizations were estimated during the years 2004-2006, yielding an average annual pesticide-related hospitalization rate of 17.8 per 100,000 population in South Korea. Age-specific rates for pesticide-related hospitalization increased with age, with the highest rate noted among those aged 70 or above. The majority of pesticide-related hospitalization was cases of intentional poisoning in rural areas. Seasonal variation in the rate was observed, with summer being the highest among both men and women.

CONCLUSIONS

Pesticide-related hospitalization is prevalent and demonstrates demographic and seasonal and regional variations. More effective strategies to reduce pesticide-related hospitalizations are required in South Korea.

Work-related pesticide poisoning among farmers in two villages of Southern China: a cross-sectional survey

Background

Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China.

Methods

A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model.

Results

A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant "dose-response" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R² = 0.9246).

Conclusions

This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning.

Health promotion outcomes associated with a community-based program to reduce pesticide-related risks among small farm households

A range of determinants at multiple socio-ecological levels operate in small farm households' use and handling of hazardous pesticides, suggesting the need for integrated health and agriculture promotion approaches. The aim is to assess changes in health promotion outcomes relevant to highly hazardous pesticide use associated with a multi-component community program. A longitudinal evaluation design using mixed methods was employed in 18 agricultural communities in Ecuador. Over a 7-month period, health education and agricultural interventions focused upon: health risks associated with hazardous pesticides, more adequate use and handling of pesticides, and better crop management techniques. Data collection included field forms, focus groups, structured observations and repeat surveys. In the qualitative analysis, communities were compared by extent of leadership and involvement with the interventions. For the quantitative analysis, hypothesized paths were constructed including factors relevant to pesticide-related practices and use. Testing involved gender-role stratified (household and crop manager) multivariable regression models. Information on pesticide health impacts and the pesticide use and handling, shared in focus groups, showed substantial improvement, as a result of health promotion activities though people were still observed to engage in risky practices in the field. In path models, community leadership and intervention intensity lead to changes in the household managers' pesticide-related knowledge and practices and to reduction in farm use of hazardous pesticides (both significant, p < 0.05). Integrated, community programs can promote pesticide-related risk reduction among small farm households. Changing practices in the use and management of pesticides among crop managers appears limited by deeper structural and cultural factors.

Pesticide poisonings at a tertiary children's hospital in South Africa: an increasing problem

CONTEXT

Exposure of children to pesticides and overt poisoning are an increasingly important problem in South Africa.

OBJECTIVE

This study describes the profile of acute paediatric pesticide exposures and poisonings presenting to Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town South Africa from 2003 to 2008, identifies those poisonings due to illicit pesticides sold on the streets ("street pesticides") and assesses the number of incidents in which the statutory requirement of notification to the local health authority is met. Methods. Cases were identified by review of the RCWMCH case and notification records and the local health authority notification records.

RESULTS

There were 306 patients with 311 incidents of acute pesticide exposure or poisoning. This represents 11% of all paediatric exposures and poisonings (N=2868) seen over the 6-year period. The number of pesticide incidents increased annually. Two hundred seventy-eight (91%) children were under 6 years old and 164 (54%) were males. Two hundred seventeen (70%) patients came from six socio economically diverse suburbs in the Cape Town Metropole, each of which ranges from informal settlements with extreme poverty to formal housing with lower to middle class populations. There was a summer predominance of acute pesticide exposures and poisonings. The commonest group of pesticides were 203 cholinergics (includes organophosphates and carbamates), 35 anticoagulants and 45 unknowns. One hundred incidents were classified as exposures as they were asymptomatic. Two hundred eleven symptomatic incidents, termed pesticide poisonings, required admission; 121 to High Care or Intensive Care Unit (ICU). The median length of stay in hospital was 3 days (range 0-52). There were 6 (2%) deaths. The large group of cholinergic exposures and poisonings (203) required 195 (96%) admissions; 120 (59%) to High Care or ICU. Of the 44 "street pesticide" exposures and poisonings, 33 were cholinergic poisonings and 21 required High Care or ICU. Eighty-seven (41%) of 211 poisonings requiring notification were recorded at the local health authority; all were instances of cholinergic poisoning.

CONCLUSION

The increasing number and the morbidity and mortality of acute paediatric pesticide exposure and poisoning is of great concern. Furthermore, the magnitude of the problem is masked by inadequate notification with the relevant health authorities.