Respiratory symptoms, fractional exhaled nitric oxide & endotoxin exposure among female flower farm workers in Ethiopia

Simultaneous real-time detection of fractional exhaled nitric oxide and end-tidal carbon dioxide by quantum cascade laser absorption spectroscopy

The simultaneous detection of fractional exhaled nitric oxide (FeNO) and end-tidal carbon dioxide (ETCO2) is of great importance for the distinguishing and diagnosis of asthma and chronic obstructive pulmonary disease (COPD), providing more comprehensive information on respiratory disorders. This work demonstrates a simultaneous ETCO2 and FeNO detection system based on quantum cascade laser absorption spectroscopy (QCLAS) technology was presented. The system employs wavelength modulation spectroscopy (WMS) technology and the Herriott multi-pass cell, achieving a detection limit of 2.82 ppb for nitric oxide (NO) and 0.05 % for carbon dioxide (CO2). Real-time exhalation measurements were performed on volunteers with varying ETCO2 and FeNO levels, and the results of the test can accurately distinguish whether the corresponding volunteer was healthy, had asthma or COPD. The effect of exhalation flow rate on the concentration of the two gases was explored. A range of expiratory flow rates were tested in the flow rate interval from 1 to 4 L/min, and there was always an inverse relationship between expiratory flow rate and FeNO concentration, but flow rate changes did not affect ETCO2 concentration. The results indicate that this detection system can simultaneously and effectively measure ETCO2 and FeNO concentrations in real-time.

A cross-sectional analysis of medical conditions and environmental factors associated with fractional exhaled nitric oxide (FeNO) in women and children from the ISA birth cohort, Costa Rica

BACKGROUND

Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures' association with elevated FeNO.

METHODS

We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children.

RESULTS

Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) CONCLUSION: Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.

Environmental exposures contribute to respiratory and allergic symptoms among women living in the banana growing regions of Costa Rica

OBJECTIVES

This research evaluates whether environmental exposures (pesticides and smoke) influence respiratory and allergic outcomes in women living in a tropical, agricultural environment.

METHODS

We used data from 266 mothers from the Infants' Environmental Health cohort study in Costa Rica. We evaluated environmental exposures in women by measuring seven pesticide and two polycyclic aromatic hydrocarbons metabolites in urine samples. We defined 'high exposure' as having a metabolite value in the top 75th percentile. We collected survey data on respiratory and allergic outcomes in mothers as well as on pesticides and other environmental exposures. Using logistic regression models adjusted for obesity, we assessed the associations of pesticide exposure with multiple outcomes (wheeze, doctor-diagnosed asthma, high (≥2) asthma score based on symptoms, rhinitis, eczema and itchy rash).

RESULTS

Current pesticide use in the home was positively associated with diagnosed asthma (OR=1.99 (95% CI=1.05 to 3.87)). High urinary levels of 5-hydroxythiabendazole (thiabendazole metabolite) and living in a neighbourhood with frequent smoke from waste burning were associated with a high asthma score (OR=1.84 (95%CI=1.05 to 3.25) and OR=2.31 (95%CI=1.11 to 5.16), respectively). Women who worked in agriculture had a significantly lower prevalence of rhinitis (0.19 (0.01 to 0.93)), but were more likely to report eczema (OR=2.54 (95%CI=1.33 to 4.89)) and an itchy rash (OR=3.17 (95%CI=1.24 to 7.73)).

CONCLUSIONS

While limited by sample size, these findings suggest that environmental exposure to both pesticides and smoke may impact respiratory and skin-related allergic outcomes in women.

A review on pesticides in flower production: A push to reduce human exposure and environmental contamination

In several countries, flower import regulations are restricted to food security, by establishing maximum residue limits (MRL) for pesticides in flower-based food products and biosafety, in order to limit the circulation of vectors, pests and exotic species across borders. In this context, the lack of limits on pesticides in flower-products for ornamental purposes can influence the pesticide overuse in production areas, as well as the transfer of contaminated products between countries. Therefore, the purpose of this review was to discuss possible adverse effects on human and environmental health of pesticides used in floriculture, evaluating regulations on the use of these pesticides in the main importing and flower-producing countries. This review included 92 documents. The use of 201 compounds was identified by interviews and analytical measurements. Among them, 93 are banned by the European Union (EU), although 46.3 % of these compounds have been identified in samples from European countries. Latin American countries have a large number of scientific publications on pesticides in flower production (n = 51), while the EU and China have less studies (n = 24) and the United States and Japan have no studies. Regarding adverse health effects, poorer neurobehavioral development, reproductive disorders, congenital malformations and genotoxicity have been reported for residents of flower production areas and workers throughout the flower production cycle. Studies including water samples show overuse of pesticides, while environmental impacts are related to water and air contamination, soil degradation and adverse effects on the reproduction and development of non-target organisms. This review points out that the absence of MRL for non-edible flowers can be crucial for the trade of contaminated products across borders, including pesticides banned in importing countries. Furthermore, setting limits on flowers could reduce the use of pesticides in producing countries.

Low levels of knowledge and practice of occupational hazards among flower farm workers in southwest Shewa zone, Ethiopia: a cross-sectional analysis

Background

Over the last decade, flower farms have been rapidly growing in Ethiopia. Following the advent and development of the sector, various work-related chemical, biological, physical, psychosocial, and ergonomic hazards have been emerging unacceptably, with increased risks of exposures for workers and local communities. However, evidence that describes knowledge and prevention practice of occupational hazards among flower farm workers in the country is little documented. The knowledge and safety practice of occupational hazards among flower farm workers in Ethiopia were explored in the current study.

Methods

A cross-sectional survey of 471 flower farm workers was implemented from March to April 2017. A stratified random sampling technique was used to select the eligible participants. An interviewer-administered questionnaire was used to collect data, and the data were entered in to Epi Info program version 7 and analyzed by SPSS program version 20. Bivariate and multivariate linear regression analyses were performed to evaluate significance of associations at < 0.05 p-values.

Results

A total of 451 flower farm workers were interviewed with a response rate of 95.7%. The majority, 72.1% (N = 325) were females. Mean age was 24.1 (SD + 6.5) years. About 39.2% (N = 177) of the participants had good knowledge on occupational hazards. The level of safety practice was 26.6% (N = 120). The level of knowledge on occupational hazards was affected by level of education [AOR: 20.03;95% CI (16.30,23.75)], work experience [AOR: 5.97; 95% CI (4.22,7.72)], and type of employment [AOR: 5.35; 95% CI (2.50,8.19)], whereas the level of safety practice was influenced by regular use of personal protective equipment (PPE) [AOR:17.53;95% CI (13.36,21.71)], level of knowledge [AOR: 7.29; 95% CI (3.87,10.73)], and provision of appropriate PPE [AOR: 4.59; 95% CI (2.34,8.86)].

Conclusion

This study revealed the levels of knowledge and safety practice towards occupational hazards were low. The knowledge on occupational hazards was significantly affected by the level of education and duration of employment. Moreover, the use of PPE and level of knowledge considerably influenced safety practice. Therefore, we recommend employers to ensure that workplace health and safety programs account for workers’ level of education and work experience. It is also pivotal to provide workers witha suitable PPE and instructions on its use, and to arrange safety communication in the local languages at the relevant workplaces.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10254-5.

Occupational exposure to pesticides and associated health effects among greenhouse farm workers

The number and production capacities of greenhouse farms have been increased across the globe, driven by an effort for addressing food security problems related to the rapid population growth and the effects of climate change. As a result, there was a large increase in the number of greenhouse farm workers who are typically involved in chemical preparations and pesticide sprayings, crop harvesting, and greenhouse maintenance activities. Considering the enclosed architecture of the greenhouse farm design and the frequent application of pesticides, the objective of this review was to characterize pesticide exposure levels and resultant health effects among greenhouse farm workers. While most health assessment studies were mainly based on self-reported symptoms, this review showed limited epidemiological and clinical studies on the assessment of the health effects of pesticide exposure on greenhouse workers' health. Reproductive disorders, respiratory symptoms, neurological symptoms, and skin irritations were the most reported health effects among greenhouse farm workers. Additionally, there were limited studies on respirable pesticide-borne fine and ultrafine particulate matters in greenhouse farms. Ventilation systems and indoor environmental conditions of greenhouse farms were not designed according to specifications of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Among recommendations provided, long-term exposure assessments of pesticide effects on children born by greenhouse farm workers should be considered in future research. Also, compliance with ASHRAE indoor ventilation and environmental standards will be very important in reducing pesticide exposure and health effects among greenhouse farm workers.

Sustainability Challenges and Innovations in the Value Chain of Flowering Potted Plants for the German Market

This study investigated the sustainability challenges and the adoption of sustainability innovations along the value chain of flowering potted plants supplying the German market. Data was collected through eighteen in-depths interviews with chain actors from different stages of the value chain and analyzed through qualitative content analysis. The material flow of the value chain begins at the breeding level followed by the propagation level. Cuttings are produced mostly in African countries, rooted cuttings and potted plants are cultivated in Europe. The main environmental challenges include water scarcity, pesticide use and carbon footprint. Social challenges in Africa include low wages and difficult working conditions. In Germany, social challenges include recruitment and retention of employees and product transparency. Economic challenges include profitability and the need to comply with standards. Sustainability driven innovations can address some sustainability challenges. However, their implementation often leads to increased costs, financial risk and complexity of implementation. Furthermore, the lack of product transparency prevents the transfer of sustainability costs to the consumer by offering a sustainable product for a premium price. Business-to-business standards have generally had a positive influence on the adoption of sustainability innovations. But by setting certification as an entry barrier for suppliers, retailers have become more powerful chain actors.

Pesticide Exposure and Health Problems Among Female Horticulture Workers in Tanzania

Commercialization of horticulture farming, expansion of farms, and the practice of monoculture favor the proliferation of pests, which in turn increases the need for pesticides. Increased exposure to pesticides is associated with inadequate knowledge on the hazardous nature of pesticides, poor hygiene practices, lack of availability of washing facilities, and insufficient adherence to precautionary instructions on pesticide labels. Mitigating the risks posed by pesticides is considered a less compelling interest than alleviating poverty. Women working in horticulture in Tanzania usually have low levels of education and income and lack decision-making power even on matters relating to their own health. This contributes to pesticide exposure and other health challenges. Because of multiple factors, some of which act as study confounders, few studies on exposure to pesticides and health effects have been conducted among women. This review identified factors that contribute to the increased health effects among women working in the horticultural industry and how these effects relate to pesticide exposure.

Occupational pesticide exposure and respiratory health: a large-scale cross-sectional study in three commercial farming systems in Ethiopia

RATIONALE

In the last decade, due to expansion of greenhouses and irrigated farms, the use of pesticides in Ethiopia has increased 6-13-fold leading to potential health risks.

OBJECTIVE

To investigate if occupational exposure to pesticides is associated with respiratory health effects in farmers and farm workers from commercial farming systems.

METHODS

We performed two cross-sectional surveys comprising different farming systems. In the first survey we studied respiratory symptoms among 1104 subjects of which 601 were occupationally exposed to pesticides (ie, 256 pesticide applicators, 345 re-entry workers) and 503 unexposed individuals. The second survey, carried out 2 years later in the same farming regions, additionally included lung function measurement and comprised a total of 387 study subjects of which 206 were occupationally exposed to pesticides (142 applicators and 64 re-entry workers) and 180 unexposed individuals.

RESULTS

We observed increased risks for chronic cough and shortness of breath (OR=3.15, 95% CI 1.56 to 6.36 and OR=6.67, 95% CI 2.60 to 17.58) among the exposed subjects as compared with unexposed individuals in the first survey. These results were corroborated in the second survey where we also observed reductions in FEV₁ (140 mL), forced expiratory flow 25%-75% (550 mL/s) and risk of FEV₁/FVC ratio <0.8 (OR=4.31, 95% CI 2.11 to 8.81) among pesticide exposed workers.

CONCLUSIONS

These findings indicate an increased risk of adverse respiratory health among workers exposed to pesticides. As those effects occurred in young workers (mean age 27 years) and within a relative short duration of exposure (4 years) implementation of stringent occupational health measures are warranted.

Prevalence and risk factors for COPD in greenhouse farmers: a large, cross-sectional survey of 5,880 farmers from northeast China

Background

COPD is one of the most common chronic diseases, and more and more farmers who were frequently exposed to greenhouse environments were diagnosed with COPD. However, little information is available on the prevalence of COPD among the greenhouse farmers. This study was conducted to assess the prevalence of COPD and investigate the potential risk factors for COPD among the Chinese greenhouse farmers.

Methods

Cross-sectional studies involving a sample of greenhouse farmers living in northeast China were performed via stratified-cluster-random sampling. All subjects were interviewed using a uniform questionnaire and underwent pulmonary function tests between 2006 and 2009, based on the diagnostic criteria of the Global Initiative for Chronic Obstructive Lung Disease. Multiple logistic regression analysis was conducted to examine the risk factors for COPD.

Results

Of the 5,880 greenhouse farmers from northeast China who were originally selected for this study, 5,420 questionnaires were completed. The overall prevalence of COPD in greenhouse farmers was 17.5%. The COPD prevalence was significantly higher in elderly subjects (≥50 years), current smokers, in those with lower body mass index (≤18.5 kg/m²) and less education, in those who were exposed to mushroom, flowers and poultry, and in those living in mountain and coastal region. Multiple logistic regression analysis revealed that age over 50 years old (odds ratio [OR]=298.69, 95% confidence interval [CI]=121.57–733.84), smoking (OR=2.18, 95% CI=1.84–2.59), planting mushroom and flowers (OR=1.46 and 1.53, 95% CI=1.13–1.87 and 1.24–1.95), and living in mountain and coastal region (OR=1.68 and 1.35, 95% CI=1.37–2.06 and 1.10–1.65) were associated with the development of COPD among greenhouse farmers.

Conclusion

In northeast China, COPD is highly prevalent among greenhouse farmers, and advanced age, smoking, planting mushroom, and flowers, as well as living in mountain and coastal regions, are potential risk factors for this disease.