Abstract
Pesticide poisoning is a major public health concern in developing countries. We conducted a population survey among farmers in three parishes of northwestern Jamaica to determine the occurrence of acute pesticide poisoning and to identify factors associated with pesticide poisoning. Approximately 16% of 359 farmers who participated in the study reported one or more incidents of acute pesticide poisoning within the last two years. Only 25% of the farmers reported ever receiving training in pesticide handling or safety. The majority (68%) of farmers who reported pesticide poisoning never sought medical attention for poisoning. The factors found to be associated with pesticide poisoning in this study indicate that implementation of specific intervention strategies and education of farmers is needed in order to improve safe handling, use and disposal of pesticides and reduce incidents of acute pesticide poisoning.
Introduction
The safe production and marketing of food is a major step towards food security. However, many farmers put themselves at risk from pesticide poisoning during the production process. This is a major public health concern, especially in developing countries where the most persistent and hazardous pesticides are used by untrained farmers.1,2 Further, pesticides that are banned, unregistered or suspended in developed countries due to their toxicity and harmful health effects are often exported to developing nations.2,3 Many of these highly toxic pesticides are applied by people with minimum or no training in safe application or storage of pesticides, and without suitable protective gear.1,2 Many developing countries do not have effective monitoring systems in place to assess the extent of pesticide poisonings and the majority of cases are unreported.4 Acute pesticide exposure can lead to death or serious illness. An estimated 99% of human pesticide fatalities occur in developing countries, although these countries account for only 20% to 30% of pesticide use. 5–7 In 1986 the World Health Organization (WHO) estimated that there were about one million cases of pesticide poisoning occurring annually.
Farmers and agricultural workers face chronic health effects from chronic exposure to pesticides.8 Chronic exposure can increase the risk of developmental and reproductive disorders, immune system disruption, endocrine disruption, impaired nervous system function and development of certain cancers.5 There is a high risk of exposure to toxic pesticides through lack of protective gear, leaky spray equipment, from mixing and applying pesticides with bare hands and storage of pesticides near food.1,2,5 Global estimates of acute pesticide poisoning are largely based on hospital data as very few studies have been conducted to study the problem of acute pesticide poisoning among agricultural workers.9 Many episodes of poisoning are not registered, as they are considered minor and in some regions information is missing because the episodes of poisoning are not registered and most patients do not seek medical attention.9,10 The milder cases that do seek care at health facilities often go unrecognized because the symptoms such as dizziness, rashes, nausea and diarrhea are similar to other health conditions.11–13 In a study conducted by Mourad (2005), 62.5% of the participants experienced burning sensations in the eyes or face and 37.5% experienced itching or irritated skin after spraying organophosphate insecticides.14
Excessive and careless use of pesticides is identified as one of the major causes of chemical poisoning in the Caribbean Region.15 Farmers in developing countries have grown dependent on pesticides to obtain high yields but this has led to increased risk of pesticide exposure and pest resistance.4,16 The dependence on pesticides makes it difficult for farmers to practice alternative pest control methods such as biological pest control and Integrated Pest Management (IPM). Biocontrol of pests has been proven effective worldwide and in the Caribbean.17 In Jamaica, a number of studies have detected high levels of residues of the organochlorine pesticide, Endosulfan, in surface water and aquatic life. Endosulfan is used across the island to control pests on coffee plants.18,19 Residues of other pesticides such as DDT, aldrin, endrin and di-eldrin, which were released into the Rio Cobre Basin a few decades ago, have been detected in coastal waters and sediment of Kingston Harbour.20 Organochlorine pesticides affect the nervous system causing convulsions, tremors, seizures and fatalities.21 Other pesticides such as chlordane and Dichlorodiphenyltrichloroethane (DDT) are associated with cancer;22 alachor, altrazine and diazinon are associated with low semen quality.23,24
The objectives of this study were to determine the occurrence of pesticide poisoning and identify factors associated with reported incidents of acute pesticide poisoning among farmers in northwestern Jamaica. These findings could be used to develop and implement strategies to encourage the safe handling, use and disposal of pesticides and decrease the occurrence of acute pesticide poisoning among farmers.
Study Design and Methods
A population survey study design was used. Participants completed an interviewer-administered questionnaire on knowledge and practices concerning the handling, use, storage and disposal of agricultural pesticides and the occurrence of episodes of pesticide poisoning. The outcome variable of interest was self-reported occurrence of acute pesticide poisoning within the last two years. Predictive variables of interest included education, years of farming experience, pesticide safety training, pesticide storage and handling practices, pesticide safety practices, and pesticide knowledge and symptoms of acute pesticide poisoning.
The study was conducted in the parishes of Westmoreland, St. James and Hanover in northwestern Jamaica from June to August 2006. Potential participants were defined as adults age 19 years and older who worked on a farm in any of the three parishes. The purpose of the study was explained to the farmers and they were asked to participate. Those who expressed interest in participating were asked to read and sign the informed consent form. If the potential participants were unable to read the consent form, the form was read to them by a member of the farm team, or a neighbor and those who were still interested in participating were asked to make an X indicating their consent. The Institutional Review Board of the University of Alabama at Birmingham, the Advisory Panel on Ethics and Medico-Legal Affairs in the Ministry of Health, Jamaica, and the Western Regional Health Authority of Jamaica approved the study protocol prior to its implementation.
Data Analysis
Absolute and relative frequencies (N and %) were obtained for the distributions of the selected variables for the two groups: those who reported one or more incidents of acute pesticide poisoning within the last two years and those who did not. The General Association Statistic was used to determine differences in the distributions of selected variables by the two groups. Trend was assessed with the Mantel Haenszel chi-square test. Odds ratios (OR) and 95% confidence intervals (CI) were generated as measures of association for all variables by the two groups. Both crude and adjusted measures of association were generated for all variables. All OR and CI were calculated from logistic regression equations. Missing values were excluded from the analysis. The analysis was conducted with SAS software, version 9.0. All reported p-values are two-tailed.
Results
Demographic and farm characteristics of the study population
The demographic and farm characteristics of the study population are shown in Table 1. Approximately 16% of the study population reported one or more incidents of acute pesticide poisoning within the last two years. Most of the participants (87%) were males. Although women constituted only 13% of the participants they accounted for 21% of participants who reported one or more episodes of acute pesticide poisoning. Farmers who completed secondary school accounted for 37% of participants who reported acute pesticide poisoning. Farmers who had 40 or more years of farming experience accounted for 11% of participants who reported episodes of acute pesticide poisoning and about 26% of the participants who did not. There were also significant differences in the distributions of pesticide poisoning on family owned versus non-family owned farms. Almost a half (47%) of farmers who worked on non-family owned farms reported acute pesticide poisoning compared to only 13% of farmers who worked on family-owned farms. Farmers who traveled 0.25 to 1 mile from their home to the farm accounted for 56% of participants who reported one or more episode of acute pesticide poisoning compared to farmers (22%) whose home was situated <0.25 miles from the farm.
Table 1.
Demographics and farm characteristics of the study population in relation to reported incident(s) of acute pesticide poisoning within the last two years.
| Characteristics | Pesticide poisoning (N=57) | No pesticide poisoning (N=302) | Total | p-value | |||
|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | ||
| Parish | |||||||
| Westmoreland | 18 | 31.6 | 119 | 39.4 | 137 | 38.2 | 0.265 |
| Hanover | 6 | 10.5 | 58 | 19.2 | 64 | 17.8 | 0.117 |
| St. James | 33 | 57.9 | 125 | 41.4 | 158 | 44.0 | 0.022 |
| Gender | |||||||
| Male | 45 | 79.0 | 267 | 88.4 | 312 | 86.9 | |
| Female | 12 | 21.1 | 35 | 11.60 | 47 | 13.1 | 0.052 |
| Age | |||||||
| 20–39 | 11 | 21.2 | 67 | 25.6 | 78 | 24.8 | 0.501 |
| 40–49 | 15 | 28.9 | 46 | 17.6 | 61 | 19.4 | 0.061 |
| 50–59 | 10 | 19.2 | 63 | 24.1 | 73 | 23.3 | 0.454 |
| 60–69 | 12 | 23.1 | 47 | 17.9 | 59 | 18.8 | 0.387 |
| 70–85 | 4 | 7.7 | 39 | 14.9 | 43 | 13.7 | 0.169 |
| Education | |||||||
| None | 0 | 0.0 | 14 | 4.7 | 14 | 4.00 | 0.103 |
| Some primary school | 16 | 29.6 | 121 | 40.9 | 137 | 39.1 | 0.120 |
| Completed primary school | 20 | 37.0 | 68 | 23.0 | 88 | 25.1 | 0.028 |
| Some secondary school | 8 | 14.8 | 40 | 13.5 | 48 | 13.7 | 0.799 |
| Completed secondary | 10 | 18.5 | 48 | 16.2 | 58 | 16.6 | 0.676 |
| Post-secondary | 0 | 0.0 | 5 | 1.7 | 5 | 1.4 | 0.337 |
| Farming experience (years) | |||||||
| 1 to 9 | 12 | 21.8 | 48 | 18.1 | 60 | 18.7 | 0.514 |
| 10 to 19 | 15 | 27.3 | 50 | 18.8 | 65 | 20.3 | 0.155 |
| 20 to 29 | 16 | 29.1 | 51 | 19.2 | 67 | 20.9 | 0.100 |
| 30 to 39 | 6 | 10.9 | 48 | 18.1 | 54 | 16.8 | 0.199 |
| 40 or more | 6 | 10.9 | 69 | 25.9 | 75 | 23.4 | 0.017 |
| Farm owned and run by family? | |||||||
| Yes | 47 | 82.5 | 291 | 96.4 | 337 | 94.2 | |
| No | 10 | 17.5 | 11 | 3.6 | 21 | 5.9 | <.001 |
| Distance from home to farm (miles) | |||||||
| <0.25 | 11 | 22.0 | 110 | 45.5 | 121 | 41.4 | 0.002 |
| 0.25 – 1 | 28 | 56.0 | 67 | 27.7 | 95 | 32.5 | <.001 |
| > 1 | 11 | 22.0 | 65 | 26.9 | 76 | 26.0 | 0.477 |
| Size is your farm (acre) | |||||||
| 0.25 – 1 | 18 | 34.6 | 80 | 28.5 | 98 | 29.4 | 0.372 |
| 1.1 – 2.9 | 10 | 19.2 | 60 | 21.4 | 70 | 21.0 | 0.731 |
| 3.0 – 9.9 | 20 | 38.5 | 102 | 36.3 | 122 | 36.6 | 0.767 |
| 10 ≥ | 4 | 7.7 | 39 | 13.9 | 43 | 12.9 | 0.222 |
BOLD alpha <0.05
Symptoms reported by farmers to be associated with acute pesticide poisoning
The most common symptoms that farmers reported experiencing as a result of acute pesticide poisoning were burning skin (13%), headaches (12%), itching eyes (11%), blurred vision (11%), dry throat (9 %), twitching eyelids (7 %), and muscle cramps (5%). The majority (68%) of affected farmers did not seek medical attention when experiencing signs and symptoms of pesticide poisoning.
Most common crops grown and pesticides used by farmers
The most common crops grown by farmers include yam, banana, dasheen, cane tomato, pepper, plantain and corn. Farmers used a variety of herbicides (paraquat, 2,4D, ametryin, ioxynil, terbutryn), fungicides (glyphosphate, copper hydroxide) and insecticides (cyhalothrin, deltamethrin, diazinon) to control pests. Most of these chemicals are moderately or slightly hazardous based on the WHO’s hazard classification.25,26
Practices of farmers in relation to reported incidents of acute pesticide poisoning
A large proportion of farmers (75%) reported that they had not received training in pesticide handling or safety (Table 2); 67% of these farmers reported incidents of acute pesticide poisoning. Approximately 26% and 37% of farmers who reported incidents of acute pesticide poisoning, stored pesticides in their homes (in a separate room for chemicals) or under their houses, respectively. There was a significant difference in report of acute pesticide poisoning by farmers in relation to whether they read the instructions on the pesticide bags before applying pesticides (p<0.001). Among farmers who reported acute pesticide poisoning, only 50% stated that they always read the instructions on the bag before applying pesticides. In comparison, 86% of farmers who reported no incidents of acute pesticide poisoning stated that they always read instructions on the bag before applying pesticides. Similar results were obtained for use of the recommended rate of pesticide by farmers and acute pesticide poisoning. Among farmers who reported acute pesticide poisoning, approximately 51% reported using the recommended amount of pesticides. In comparison 71% of farmers who did not report acute pesticide poisoning reported using the recommended amount of pesticides (p= 0.0037). Framers who reported using pesticides in their houses to kill pests accounted for 21% of participants who reported acute pesticide poisoning and 2.3% of those who reported no poisoning (p<0.001). Twelve of nineteen farmers (63%) who reported using pesticides in their houses to kill pests reported incidents of acute pesticide poisoning.
Table 2.
Practices of the study population in relation to reported incident(s) of acute pesticide poisoning within the last two years.
| Characteristics | Pesticide poisoning (N=57) | No pesticide poisoning (N=302) | Total | p-value | |||
|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | ||
| Training in pesticide use and/or safety? | |||||||
| Yes | 19 | 33.3 | 70 | 23.2 | 89 | 24.8 | |
| No | 38 | 66.7 | 232 | 76.8 | 270 | 75.2 | 0.104 |
| Ever stored pesticides in home but in a separate room for chemicals? | |||||||
| Yes | 15 | 26.3 | 37 | 12.3 | 52 | 14.5 | |
| No | 42 | 73.7 | 264 | 87.7 | 306 | 85.5 | 0.006 |
| Ever stored pesticides under your house? | |||||||
| Yes | 21 | 36.8 | 68 | 22.6 | 89 | 24.9 | |
| No | 36 | 63.2 | 233 | 77.4 | 269 | 75.1 | 0.023 |
| Always read the instructions before use? | |||||||
| Always | 26 | 50.0 | 246 | 86.3 | 272 | 80.7 | <0.001 |
| Sometimes | 14 | 26.9 | 25 | 8.8 | 39 | 11.6 | <0.001 |
| Never | 12 | 23.1 | 14 | 4.9 | 26 | 7.7 | <0.001 |
| Always use the recommended rate of pesticide? | |||||||
| Yes | 29 | 50.9 | 213 | 70.5 | 242 | 67.4 | |
| No | 28 | 49.1 | 89 | 29.5 | 117 | 32.6 | 0.004 |
| Ever used crop or animal pesticides in the house to kill pests? | |||||||
| Yes | 12 | 21.1 | 7 | 2.3 | 19 | 5.3 | |
| No | 45 | 79.0 | 295 | 97.7 | 340 | 94.7 | <.001 |
| Wear gloves when applying pesticides? | |||||||
| Always | 24 | 42.1 | 135 | 44.7 | 159 | 44.3 | 0.718 |
| Sometimes | 18 | 31.6 | 99 | 32.8 | 117 | 32.6 | 0.859 |
| Never | 15 | 26.3 | 68 | 22.5 | 83 | 23.1 | 0.533 |
| Use a mask/respirator when handling pesticides? | |||||||
| Always | 22 | 38.6 | 133 | 44.0 | 155 | 43.2 | 0.447 |
| Sometimes | 11 | 19.3 | 86 | 28.5 | 97 | 27.0 | 0.153 |
| Never | 24 | 42.1 | 83 | 27.5 | 107 | 29.8 | 0.027 |
| Use protective eyewear when applying pesticides? | |||||||
| Always | 15 | 26.3 | 100 | 33.1 | 115 | 32.0 | 0.314 |
| Sometimes | 11 | 19.3 | 70 | 23.2 | 81 | 22.6 | 0.521 |
| Never | 31 | 54.4 | 132 | 43.7 | 163 | 45.4 | 0.138 |
| Wear special shoes (no other use) when applying pesticides? | |||||||
| Always | 43 | 75.4 | 279 | 92.4 | 322 | 89.7 | 0.001 |
| Sometimes | 7 | 12.3 | 6 | 2.0 | 13 | 3.6 | 0.001 |
| Never | 7 | 12.3 | 17 | 5.6 | 24 | 6.7 | 0.066 |
| Use special tools (no other use) to mix and apply pesticides? | |||||||
| Always | 47 | 82.5 | 281 | 93.1 | 328 | 91.4 | 0.009 |
| Sometimes | 5 | 8.8 | 11 | 3.6 | 16 | 4.5 | 0.086 |
| Never | 5 | 8.8 | 10 | 3.3 | 15 | 4.2 | 0.059 |
| What do you do with your empty pesticide containers? | |||||||
| Burn them | 43 | 75.4 | 207 | 68.5 | 250 | 69.6 | 0.300 |
| Bury them | 22 | 38.6 | 112 | 37.1 | 134 | 37.8 | 0.830 |
| Drop them at the public dump | 8 | 14.0 | 22 | 7.3 | 30 | 8.4 | 0.092 |
| Throw them in the bushes | 24 | 42.1 | 67 | 22.2 | 91 | 25.4 | 0.002 |
| Throw them in the stream | 1 | 1.8 | 3 | 1.0 | 4 | 1.1 | 0.616 |
BOLD alpha < 0.05
With regard to protective gear, farmers who reported that they never use a mask or respirator when handling pesticides accounted for 42% of participants who reported acute pesticide poisoning and 27% of participants who did not report acute pesticide poisoning (p=0.27) (Table 2). About 45% of the farmers reported that they never use protective eyewear and 23% reported never using gloves when applying pesticides. However, no significant differences were found between use of gloves or protective eyewear and reported incidents of acute pesticide poisoning. Wearing special shoes (for pesticide application only) by farmers when applying pesticide was significantly associated with prevention of pesticide poisoning (p<0.001). The overwhelming majority (87%) of farmers who reported always wearing special shoes when applying pesticides reported no pesticide poisoning.
About 18% of farmers reported that they washed pesticide application tools in streams. Farmers who washed pesticide application tools in streams accounted for 30% of participants who reported acute pesticide poisoning and 16% of participants who did not report pesticide poisoning (p=0.012). Although, only 3% of farmers reported using empty pesticide containers to collect or store farm water, these farmers accounted for 16% of participants who reported pesticide poisoning; in comparison only 1% of farmers who did not report pesticide poisoning (p< 0.001). Farmers who reported that they threw empty pesticide containers in bushes accounted for 42% of participants who reported acute pesticide poisoning (Table 2); in comparison 22% of these farmers did not report pesticide poisoning (p-value =0.002).
Association between knowledge of pesticides and farmers report of acute pesticide poisoning
Table 3 shows that approximately half of the farmers reported that they did not know the difference between a fungicide and a herbicide. About 59% of farmers reported that they had heard of pesticide awareness week. Farmers who reported that pesticides enter the body through the eyes constituted about 77% of participants who reported acute pesticide poisoning and were significantly different (p =0.014) from those who reported no pesticide poisoning (89%). Farmers who reported that pesticides enter the body through the palms of the hand constituted 63% of those who reported acute pesticide poisoning and were significantly different (p<0.001) from those who reported no pesticide poisoning (84%). Large percentages (91%) of farmers knew that people can get sick from pesticide runoff and that water can be polluted from pesticide runoff. Approximately 85% of farmers reported that they used pesticides to obtain high yields and better crop quality. The majority of farmers (71%) reported that pesticides did not pose a health problem in their community, however, 51% of these farmers reported episodes of acute pesticide poisoning compared to 75% who did not report acute poisoning (p-value =<0.001; Table 3).
Table 3.
Knowledge about pesticides by the study population in relation to reported incident(s) of acute pesticide poisoning within the last two years.
| Characteristics | Pesticide poisoning (N=57) | No pesticide poisoning (N=302) | Total | p-value1 | |||
|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | ||
| Know the difference between fungicide and herbicide | |||||||
| Yes | 33 | 57.9 | 149 | 49.3 | 182 | 50.7 | |
| No | 24 | 42.1 | 153 | 50.7 | 177 | 49.3 | 0.237 |
| Heard of pesticide awareness week? | |||||||
| Yes | 33 | 57.9 | 177 | 58.6 | 210 | 58.5 | |
| No | 24 | 42.1 | 125 | 41.4 | 149 | 41.5 | 0.920 |
| Routes pesticides can enter the body? | |||||||
| Skin | 49 | 86.0 | 267 | 88.4 | 316 | 88.0 | 0.603 |
| Lungs (breathing) | 52 | 91.2 | 282 | 93.4 | 334 | 93.0 | 0.559 |
| Eyes | 44 | 77.2 | 269 | 89.1 | 313 | 87.2 | 0.014 |
| Palms of the hands | 36 | 63.2 | 255 | 84.4 | 291 | 81.1 | <0.001 |
| Mouth | 55 | 96.5 | 281 | 93.1 | 336 | 93.6 | 0.331 |
| Do people get sick from pesticide runoff? | |||||||
| Yes | 52 | 91.2 | 276 | 91.4 | 328 | 91.4 | |
| No | 5 | 8.8 | 26 | 8.6 | 31 | 8.6 | 0.968 |
| Is the water polluted from pesticide runoff? | |||||||
| Yes | 53 | 93.0 | 273 | 90.4 | 326 | 90.8 | |
| No | 4 | 7.0 | 29 | 9.6 | 33 | 9.2 | 0.536 |
| Can a farmer obtain the same yields without pesticides? | |||||||
| Yes | 10 | 17.5 | 43 | 14.2 | 53 | 14.8 | |
| No | 47 | 82.5 | 259 | 85.8 | 306 | 85.2 | 0.519 |
| Will the food be the same quality without pesticides? | |||||||
| Yes | 10 | 17.5 | 45 | 14.9 | 55 | 15.3 | |
| No | 47 | 82.5 | 257 | 85.1 | 304 | 84.7 | 0.612 |
| Do pesticides pose a health problem in your community? | |||||||
| Yes | 28 | 49.1 | 76 | 25.2 | 104 | 29.0 | |
| No | 29 | 50.9 | 226 | 74.8 | 255 | 71.0 | <0.001 |
BOLD alpha < 0.05
Association between pesticide application equipment and farmers report of acute pesticide poisoning
Table 4 shows that a large proportion of farmers (85%) use backpack sprayers to apply pesticides. Farmers who used a handheld sprayers represented 63% of farmers who reported acute pesticide poisoning (p<0.001). Farmers who used band sprayers accounted for 5% of those who reported pesticide poisoning and 1% of those who did not (p=0.022).
Table 4.
Equipment used by the study population in relation to reported incident(s) of acute pesticide poisoning within the last two years.
| Equipment | Pesticide poisoning (N=57) | No pesticide poisoning (N=302) | Total | p-value | |||
|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | ||
| Use handheld sprayer | 36 | 63.2 | 87 | 28.8 | 123 | 34.3 | <0.001 |
| Use backpack sprayer | 49 | 86.0 | 255 | 84.4 | 304 | 84.7 | 0.769 |
| Use band sprayer | 3 | 5.3 | 3 | 1.0 | 6 | 1.7 | 0.022 |
| Use gas canister | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | |
| Use mist blower or fogger | 3 | 5.3 | 10 | 3.32 | 13 | 3.6 | 0.473 |
| Use pretreated seed | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | |
| Use duster applicator | 0 | 0.0 | 1 | 0.33 | 1 | 0.3 | 0.663 |
BOLD alpha < 0.05
Multivariate logistic regression
For the final adjusted model (Table 5), all statistically significant variables from the primary analyses were entered into a logistic regression model. Backward stepwise logistic regression was performed. Variables with a statistical significance of p<0.10 were retained. Variables that appeared to act as confounders were also retained. In the final model, farmers who were 40–49 years of age were almost 6 times more likely to report an occurrence of acute pesticide poisoning in the last two years, compared to farmers in the youngest age group (20–39 years) (95% CI:1.48, 23.94). Overall, reports of acute pesticide poisoning appeared to decrease with age. However, the associations in the other age categories failed to achieve statistical significance.
Table 5.
Crude and adjusted prevalence odds ratios (POR) with 95% confidence intervals (CI) for the study population according to self-reported incidence of acute pesticide poisoning within the last two years
| Variables | Crude OR (95%) | Adjusted OR (95% CI) |
|---|---|---|
| Age | ||
| 20–39 | Reference | Reference |
| 0–49 | 1.99 | 5.95 (1.48, 23.94) |
| 50–59 | 0.97 | 3.49 (0.71, 17.29) |
| 60–85 | 1.13 | 1.81 (0.30, 10.97) |
| Completed primary school | ||
| Yes | 1.74 | 0.62 (0.22, 1.70) |
| No | Reference | Reference |
| Size of farm (acre) | ||
| 0.25–1 | 2.32 | 0.55 (0.11, 2.64) |
| 1.1–2.9 | 1.63 | 0.34 (0.06, 1.99) |
| 3–3.9 | 1.91 | 0.24 (0.04, 1.35) |
| ≥10 | Reference | Reference |
| Distance from home to farm (miles) | ||
| <0.25 | Reference | Reference |
| 0.25–1 | 4.18 | 4.44 (1.19, 16.56) |
| ≥1 | 1.69 | 0.57 (0.15, 2.14) |
| Farm owned and run by family | ||
| Yes | 0.18 | 0.04 (0.01, 0.25) |
| No | Reference | Reference |
| Farming experience (years) | ||
| 1–9 | 2.88 | 2.45 (0.30, 20.04) |
| 10–19 | 3.45 | 2.87 (0.45, 18.50) |
| 20–29 | 3.61 | 7.71 (1.43, 41.58) |
| 30–39 | 1.44 | 2.60 (0.43, 15.83) |
| ≥40 | Reference | Reference |
| Always read instructions before use | ||
| Yes | 0.16 | 0.12 (0.04, 0.41) |
| No | Reference | Reference |
| Always use recommended rate of pesticide | ||
| Yes | 0.43 | 1.42 (0.49, 4.05) |
| No | Reference | Reference |
| Ever stored pesticide in home, but in separate room for chemicals | ||
| Yes | 2.55 | 0.66 (0.15, 2.81) |
| No | Reference | Reference |
| Ever stored pesticide under house | ||
| Yes | 2.00 | 3.02 (0.99, 9.19) |
| No | Reference | Reference |
| Ever used crop or animal pesticide in home to kill pests | ||
| Yes | 11.24 | 2.12 (0.41, 10.86) |
| No | Reference | Reference |
| Use handheld sprayer to apply pesticides | ||
| Yes | 4.24 | 4.00 (1.55, 10.34) |
| No | Reference | Reference |
| Use a mask/respirator when handling pesticides | ||
| Always | Reference | |
| Sometimes | 0.77 | 1.27 (0.34, 4.78) |
| Never | 1.75 | 3.15 (1.05, 9.47) |
| Wear special shoes (no other use) when applying pesticide | ||
| Yes | 0.25 | 1.28 (0.29, 5.69) |
| No | Reference | Reference |
| Always use special tools (no other use) to mix and apply pesticides | ||
| Yes | 0.35 | 0.18 (0.05, 0.69) |
| No | Reference | Reference |
| Ever use empty pesticide container to collect and/or store farm water | ||
| Yes | 18.69 | 8.10 (0.74, 88.40) |
| No | Reference | Reference |
Farmers who traveled 0.25 to 1 mile from their home to the farm were 4.44 times more likely to report symptoms of acute pesticide poisoning in the last two years compared to farmers whose farms were less than 0.25 miles from their homes (95% CI: 1.19, 16.56). Compared to farmers who worked on non-family farms, those who worked on family farms were 96% less likely to report episodes of acute pesticide poisoning (95% CI: 0.01, 0.25). There was a significant association between farming experience of 20–29 years and acute pesticide poisoning (95% CI: 1.43, 41.58). Always reading pesticide instructions before use was associated with a decreased risk of acute poisoning among farmers (OR=0.12, 95% CI: 0.004, 0.41). Use of a hand-held sprayer to apply pesticides was associated with a 4-fold increased risk of acute pesticide poisoning (95% CI: 1.55, 10.34). Farmers who reported never using a mask or respirator when handling pesticides were nearly 3 times more likely to report acute pesticide poisoning compared with farmers who reported that they always used a mask or respirator (95% CI: 1.05, 9.47). Farmers who reported using special tools (no other use) to mix and apply pesticides were 82% less likely to report acute pesticide poisoning compared to farmers who used tools for multiple purposes including pesticides (95% CI:0.05,0.69).
Discussion
Only one-quarter of the farmers in this study reported ever receiving training in pesticide handling or safety. This finding is consistent with previous studies conducted in developing countries as most developing nations lack resources to train and educate farmers in safe pesticide handling and use.6,27 Approximately (16%) of farmers in the study reported one or more incidents of acute pesticide poisoning within the last two years. Of these, only 32% consulted a clinic, hospital or private doctor following the accidental poisoning. This degree of underreporting is consistent with results of other studies.28–30 A study by Maumbe and Swinton (2003) which determined health costs of pesticide use among Zimbabwe’s smallholder cotton growers found that 7–12% of famers reported pesticide poisoning. However, only 2–8% of these cases sought medical attention and the majority relied upon home-made treatments and prayer to relieve their health ailments. The cost and efficacy of clinical treatments were reported as reasons why the farmers did not seek medical attention.29 This might be the case in our study, since most farmers in developing countries face financial hardship and lack health insurance.29,31,32 In addition, most medical professionals lack the ability to identify pesticide related illnesses, 12,29 thus raising further concerns. Underreporting of pesticide poisonings is a major problem in the developing world, especially in occupational settings.33,34 Medical attention is mainly given to suicide attempts with pesticide due to the greater severity of illness.31,34
Farmers aged 40–49 years and farmers with 20–29 years of farming experience were more likely to report experiencing pesticide poisoning than other farmers. Our study findings are in contrast to other studies whereby younger and less experienced farmers reported higher incidence rates of poisoning.33,35 This may be explained by a variety of factors including repeated exposure over years and longer working hours compared to younger inexperienced farmers.30
This study also showed that the likelihood of occurrence of acute pesticide poisoning increased with distance from home to the farm. Our findings are in contrast with other studies that have reported greater exposure to pesticide with increased residential proximity to farms.36–42 Due to a lack of facilities on the farm, it is difficult for famers who live further away from home to wash off or change clothes after applying pesticides.31,32,43 In addition, perspiration in clothing soaked with pesticides for longer periods greatly increases the likelihood of dermal absorption.28,31,32. Farmers on Family-owned farms were less likely to report incidents of acute pesticide poisoning than farmers on non-family owned farms. Professional or waged workers are exposed to pesticide for longer times, spray frequently, use pesticides chosen by their employers and have no control over work conditions, thus increasing their vulnerability to pesticide poisoning.28,30 These factors may explain reports of pesticide poisoning by waged workers in this study. As anticipated, farmers who did not read instructions on the bag before applying pesticides or use the recommended amount had an increased likelihood of acute pesticide poisoning. Therefore, training in pesticide use and safety could greatly reduce the risk of pesticide exposure.6,8,28 Farmers who used handheld sprayers were four times more likely to report acute pesticide poisoning than farmers who used other methods of pesticide application. Handheld sprayers are inexpensive pesticide application tools used on small farms and in many developing countries.44–46 However, handheld sprayers are known for leaking,43,47 thus posing a great risk of exposure to harmful pesticides. Previous research on handheld sprayers has documented the greatest risk of pesticide exposure compared to other methods of application.46,48 There is a greater risk of dermal exposure because the hands are the most exposed region of the body.48 In addition, most farmers in this study did not receive training in pesticide safety nor wore protective gear, further increasing the likelihood of poisoning.25 Given the grave danger of using leaky spray equipment, farmers often do not have the resources to repair or to buy new safe pesticide application tools. 43,44 Farmers who reported always using special tools for mixing and applying pesticides were less likely to report pesticide poisoning than farmers who did not. Mixing or applying pesticides places the famer in direct contact with pesticides resulting in harmful effects. The use of safe pesticide mixing and application tools greatly reduces dermal exposure.46,48
This study also showed that the likelihood of acute pesticide poisoning was reduced when a mask or respirator was used. Pesticide dusts and vapors are easily absorbed by the lungs and respiratory system.49 The use of personal protective devices such as masks and respirators can reduce the risk of pesticide exposure or inhalation; however, protective gear is expensive, uncomfortable to wear and can increase the dermal absorption of pesticides in tropical climates.2,11,28,30,50 Thus, the replacement of pesticides with non-toxic or less-toxic alternatives seems feasible in this tropical and resource limited country. 30,32 For example, the implementation of the integrated pest management (IPM) or biological control of crop pests would be a viable alternative. IPM has been proven effective in many parts of the world and in the Caribbean.17,28,32 Studies on IPM have documented that farmers who went through IPM training sprayed less often and reduced their use of more highly toxic pesticides while still achieving the same crop yields as before.28 Restricting pesticide use, especially the most toxic pesticides will reduce cases of pesticide poisoning and present a pathway for preventive programs.30–32 Minimizing pesticide use will take years; in the meantime, the most human health and environmental hazardous pesticides should be restricted.31
Conclusion
Training and educating farmers in safe use and handling of pesticides should reduce incidents of acute pesticide poisoning. The training program should emphasize the need to always use protective gear and the recommended amount of pesticides. Due to limited resources, training and health education can be done in the communities. The infrastructure that currently exists in Jamaica can be extended to implement new farming techniques including the use of IPM. For instance, the Rural Agricultural Development Authority (RADA) which oversees the development of agriculture and economic growth in rural Jamaican communities can implement rural extension services. RADA personnel can conduct short courses and seminars to community leaders who in turn will educate farmers. Overall, this study shows the need for further research on pesticide handling, knowledge and practices among Jamaican farmers. Alternatives to pesticide use such as biological pest control and IPM should be considered or implemented to reduce reports of acute pesticide poisoning.
Acknowledgments
This study was supported by Minority Health International Research Training (MHIRT) grant # T37-MD001448 from the National Center on Minority Health and Health Disparities, National Institutes of Health, USA and the Ministry of Health, Jamaica. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. We thank officials at the Rural Agricultural Development Authority (RADA), Jamaica and our research assistant for their help. We are grateful to the farmers who participated in the study.
References
- 1.WHO Expert Committee on Vector Biology and Control. WHO technical report series. Geneva: World Health Organization; 1985. Safe use of pesticides: ninth report of the WHO Expert Committee; p. 720. [PubMed] [Google Scholar]
- 2.United States General Accounting Office. Pesticides: Export of unregistered pesticides is not adequately monitored by EPA. Washington, D.C: U.S. General Accounting Office; 1989. [Google Scholar]
- 3.Weir D, Schapiro M. Circle of Poison: Pesticides and People in a hungry World. San Francisco, CA: Institute for food and development policy; 1981. [Google Scholar]
- 4.Ecobichon D. Pesticide use in developing countries. Toxicology. 2001;160:27–33. doi: 10.1016/s0300-483x(00)00452-2. [DOI] [PubMed] [Google Scholar]
- 5.WHO in collaboration with UNEP. Public Health impact of pesticides used in agriculture. Geneva: World Health Organization; 1990. [Google Scholar]
- 6.Wesseling C, Ahlbom A, Antich H, Rodriguez AC, Castro R. Cancer and banana plantation workers in Costa Rica. Int J Epidemiol. 1996;25(6):1125–1131. doi: 10.1093/ije/25.6.1125. [DOI] [PubMed] [Google Scholar]
- 7.Dinham B. The Pesticide Hazard: A Global Health and Environment Audit. Atlantic Highlands, NJ: Zed Books; 1993. [Google Scholar]
- 8.Antle J, Pingali P. Pesticides, productivity, and farmer health: A Philippine case study. Amer J Agr Econ. 1994;76:418–430. [Google Scholar]
- 9.Jeyaratnam J. Acute pesticide poisoning: A major global health problem. World Health Statistics Quarterly. 1990;43:139–144. [PubMed] [Google Scholar]
- 10.Kaloyanova FP, El-Batawi MA. Human Toxicology of Pesticides. Boca Raton, FL: CRC Press; 1991. [Google Scholar]
- 11.United States General Accounting Office. Pesticides on farms: Limited capability exists to monitor occupational illness and injuries. Washington, D.C: U.S. General Accounting Office; 1993. [Google Scholar]
- 12.Solomon G, Ogunesitan OA, Kirsch J. Physicians for social responsibility and Californians for reform. 2000. Pesticides and human health: a resource for health care professionals. [Google Scholar]
- 13.Ecobichon DJ, Joy RM. Pesticides and Neurological Diseases. 2. Boca Raton; FL: CRC Press; 1994. [Google Scholar]
- 14.Mourad TA. Adverse impact of insecticides on the health of Palestinian farm workers in the Gaza Strip: A Hematologic Biomarker Study. Int J Occup Environ Health. 2005;11:144–149. doi: 10.1179/oeh.2005.11.2.144. [DOI] [PubMed] [Google Scholar]
- 15.Hoaglnad P, Schumacher ME, Gaines AG., Jr . Technical Report No WHOI-95–10. Woods Hole Oceanographic Institute; 1995. Toward an effective protocol on land-based marine pollution in the wider Caribbean. [Google Scholar]
- 16.Jumanah F. Pesticide Policies in Developing Countires: Do they encourage excessive use? Washington D.C: World Bank; 1994. [Google Scholar]
- 17.Cruz C, Segarra A. Potential for biological control of crop pests in the Caribbean. Florida Entomologist. 1992;75:400–408. [Google Scholar]
- 18.Robinson DE, Mansingh A. Insecticide contamination of Jamaica environment. IV. Transport of Residues from coffee plantations in the Blue Mountains to coastal waters in eastern Jamaica. Environ Monit Assess. 1999;54:125–141. [Google Scholar]
- 19.Witter JV, Robinson DE, Mansingh A, Dalip KM. Insecticide contamination of Jamaica environment. IV. Island-wide rapid survey of residues in surface and ground water. Environ Monit Assess. 1999;56:257–267. [Google Scholar]
- 20.Mansingh A, Wilson A. Pesticide contamination of Jamaica environment. III. Baseline studies on the status of insecticide pollution of Kingston Harbour. Mar Pol Bul. 1995;30(10):640–645. [Google Scholar]
- 21.Reigart J, Roberts J. Recognition and management of pesticide poisonings. United States Environmental Protection Agency; 1999. [Google Scholar]
- 22.Zahn S, Blair A. Pesticides and Non-Hodgkin’s Lymphoma. Cancer Res. 1992;52:5485–5488. [PubMed] [Google Scholar]
- 23.Yucra S, Rubio J, Gasco M, et al. Semen quality and reproductive sex hormone levels in Peruvian pesticide sprayers. Int J Occup Environ Health. 2006;12:355–361. doi: 10.1179/oeh.2006.12.4.355. [DOI] [PubMed] [Google Scholar]
- 24.Swan SH, Kruse RL, Lie F, et al. Semen quality in relation to biomarkers of pesticide exposure. Environ Health Perspect. 2003;111(12):1478–1484. doi: 10.1289/ehp.6417. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Ncube N, Bessler P, Jolly PE, et al. Pesticide use and human health in Northwestern Jamaica. Proceeding of the 26th West Indies Agricultural Economics Conference; 2007. pp. 137–147. [Google Scholar]
- 26.WHO. The WHO recommended classification of pesticide by hazard and guidelines to classification. Geneva: 2005. [Google Scholar]
- 27.Jors E, Morant R, Aguilar G, Huici O, Lander F, Baelum J, Konradsen F. Occupational pesticide exposure intoxications among farmers in Bolivia: a cross-sectional study. Environ Health. 2006;5:10. doi: 10.1186/1476-069X-5-10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Kishi M, Hirschhorn N, Djajadisastra M, Sattarlee LN, Strowman S, Dilts R. Relationship of pesticide spraying to signs and symptoms in Indonesian farmers. Scand J Work Environ Health. 1995;21:124–133. doi: 10.5271/sjweh.19. [DOI] [PubMed] [Google Scholar]
- 29.Maumbe BM, Swinton SM. Hidden health costs of pesticide use in Zimbabwe’s smallholder cotton growers. Soc Sci Med. 2003;57:1559–1571. doi: 10.1016/s0277-9536(03)00016-9. [DOI] [PubMed] [Google Scholar]
- 30.Mancini F, Bruggen AHC, Jiggins LS, Ambatipudi AC, Murphy H. Acute pesticide poisoning among female and male cotton growers in India. Int J Occup Environ Health. 2005;11:221–232. doi: 10.1179/107735205800246064. [DOI] [PubMed] [Google Scholar]
- 31.Eddleston M, Karalliedde L, Buckley N, et al. Pesticide poisoning in the developing world-a minimum pesticides list. Lancet. 2002;360:163–1167. doi: 10.1016/s0140-6736(02)11204-9. [DOI] [PubMed] [Google Scholar]
- 32.Konradsen F, van der Hoek W, Cole D, et al. Reducing acute poisoning in developing countries-options for restricting the availability of pesticides. Toxicology. 2003;192:249–261. doi: 10.1016/s0300-483x(03)00339-1. [DOI] [PubMed] [Google Scholar]
- 33.Keifer M, McConnell R, Pacheco AF, Daniel W, Rosenstock L. Estimating underreported pesticide poisoning in Nicaragua. Am J Ind Med. 1996;30:195–201. doi: 10.1002/(SICI)1097-0274(199608)30:2<195::AID-AJIM10>3.0.CO;2-S. [DOI] [PubMed] [Google Scholar]
- 34.London L, Bailie R. Challenges for improving surveillance for pesticide poisoning: policy implications for developing countries. Int J Epidemiol. 2001;30:564–570. doi: 10.1093/ije/30.3.564. [DOI] [PubMed] [Google Scholar]
- 35.McConnell R, Anton FP, Magnotti R. Crop duster aviation mechanics: high risk for pesticide poisoning. Am J Public Health. 1990;40(10):1236–1239. doi: 10.2105/ajph.80.10.1236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Simcox NJ, Fenske RA, Wolz SA, Lee I, Kalman DA. Pesticides in households dust and soil: Exposure for children of agricultural families. Environ Health Perspect. 1995;103:1126–1134. doi: 10.1289/ehp.951031126. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Lowenherz C, Fenske RA, Sincox NJ, Bellamy G, Kalman D. Biological monitoring of organophosphorus pesticide exposure among children of agricultural workers in central Washington state. Environ Health Perspect. 1997;105:1344–1353. doi: 10.1289/ehp.971051344. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Gladen BC, Sandler DP, Zahm SH, Kamel F, Rowland AS, Alavanja MCR. Exposure opportunities of families of farmer pesticide applicators. Am J Ind Med. 1998;34:581–587. doi: 10.1002/(sici)1097-0274(199812)34:6<581::aid-ajim6>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- 39.Ward MH, Nuckols JR, Weigel SJ, Maxwell SK, Cantor KP, Miller RS. Identifying populations potentially exposed to agricultural pesticides using remote sensing and a geographic information system. Environ Health Perspect. 2000;108:5–12. doi: 10.1289/ehp.001085. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Curl CL, Fenske RA, Kissel JC, et al. Evaluation of take-home organophosphorus pesticide exposure among agricultural workers and their children. Environ Health Perspect. 2002;110:787–792. doi: 10.1289/ehp.021100787. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Curwin BD, Hein MJ, Sanderson WT, et al. Pesticide contamination inside farm and nonfarm homes. J Occup Environ Hygiene. 2005;2:357–367. doi: 10.1080/15459620591001606. [DOI] [PubMed] [Google Scholar]
- 42.Roberts EM, English PB, Grether JK, Windham GC, Somberg L, Wolff C. Maternal residence near agricultural pesticide applications and autism spectrum disorders among children in the California Central Valley. Environ Health Perspect. 2007;115:1482–1489. doi: 10.1289/ehp.10168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Jeyaratnem J. Health problems of pesticide usage in the third world. Br J Ind Med. 1985;42:505–506. doi: 10.1136/oem.42.8.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.McConnell R, Hruska A. An epidemic of pesticide poisoning in Nicaragua: Implications for prevention in developing countries. Am J Public Health. 1993;83:1559–1562. doi: 10.2105/ajph.83.11.1559. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Sumner PE. Handheld and backpack sprayers for applying pesticides. The University of Georgia College of Agricultural and Environmental Sciences Athens; 1997. [Google Scholar]
- 46.Choi H, Moon JK, Liu KH, et al. Risk assessment of human exposure to cypermerthrin during treatment of mandarin fields. Arch Environ Contam Toxicol. 2006;50:437–442. doi: 10.1007/s00244-005-1050-3. [DOI] [PubMed] [Google Scholar]
- 47.Watts M. Reducing risk with better application technology: a public interest perspective. Pesticide Action Network; 2009. [Google Scholar]
- 48.Nuyttens D, Braekman P, Windey S, Sonck B. Potential dermal pesticide exposure affected by greenhouse spray application technique. Pest Manag Sci. 2009;65:781–790. doi: 10.1002/ps.1755. [DOI] [PubMed] [Google Scholar]
- 49.Ogg CL, Schulze DL. Protective clothing and equipment for pesticide applicators. University of Nebraska-Lincoln; 2002. [Google Scholar]
- 50.Mekonnen Y, Agonafir T. Pesticide sprayers’ knowledge, attitude and practice of pesticide use on agricultural farms of Ethiopia. Occup Med. 2002;52(6):311–315. doi: 10.1093/occmed/52.6.311. [DOI] [PubMed] [Google Scholar]