Role of pharmacist in assessment and education regarding
awareness of organophosphorus poisoning a study in selected
villages of Gulbarga district
Vinod Immanuel1*, S.S.Biradar2.Shakeel Ahamed3
1. PG Research Student, Dept. of Pharmacy Practice, BTGH, HKES’ MTRIPS,
Gulbarga, Karnataka, India.
2. S.S Biradar,Asst. Professor, Dept. of Pharmacy Practice, BTGH, HKES’ MTRIPS,
Gulbarga, Karnataka, India.
3. Shakeel Ahamed, Lecturer, Dept. of Clinical Pharmacy, KCT College of pharmacy,
Gulbarga, Karnataka, India.
Address for Correspondence*
Vinod Immanuel
M.Pharma
Department of Pharmacy Practice,
H K E’S Matoshree Taradevi Rampure
Institute of Pharmaceutical sciences,
Sedam Road, Gulbarga - 585 105.
E-mail: vinodimmanuel@gmail.com
Mobile: 9731476309.
ABSTRACT
The insecticides (OP) which have been developed to protect crops are now themselves
causing significant morbidity and mortality by means of environmental pollution and suicidal
use. Hence the present study was carried out to assess and educate the people for creating
awareness in handling of OP-poisoning. The main objective of the present study was to
assess the knowledge, attitude and handling of toxic effects of OP-poisoning, and to create an
awareness regarding the storage, usage and first aid measures to avoid accidental/
occupational poisoning. A total of 150 farmers were enrolled in to the study at Farthabad
village of Gulbarga district, out of which 124 were male and 26 were female considered as
study subjects. The pre-designed and pre-tested oral/written questionnaire were administered
to the study subjects before and after educational programme and data’s were collected and
analyzed under the five aspects of knowledge, they are storage, handling before spray,
handling after spray, OP-poisoning and first aid measures by using student ‘t’ test. The results
revealed that there was significant improvement in the knowledge scores after the educational
intervention. It was statistically (p<0.0001) highly significant. The study concludes that there
is an increase in the need of agrochemical poisoning related information among the
agricultural workers in Farthabad village of Gulbarga district.
Key words: Organophosphorus poisoning, educational intervention, leaflets, agricultural
farmers, insecticides, Crops, Toxicity.
INTRODUCTION
Due to the vast development in all the fields of life like industries, medicine and agriculture, a
significant number of new compounds have appeared as new poisonous substances.
Organophosphorus (OP) compounds can produce significant pesticide related illnesses and
death in developing countries, including India.1
The common use of insecticides in public health and agricultural schedules has caused
severe environmental pollution and potential health hazards including severe acute and
chronic cases of human and animal poisonings.2
Poisoning intentional and accidental was significant contributor to mortality and morbidity
throughout the world. According to WHO, three million acute poisoning cases with 2, 20,000
deaths occurs annually throughout the world. Out of these 90% of poisoning cases belongs to
developing countries particularly among the agricultural workers3.
Acute organophosphorus poisoning occurs after or oral exposure to either low volatility
pesticides (e.g., chlorpyrifos, dimethoate) or high volatility nerve agents (e.g., sarin,
tabun).Inhibition of acetylcholinesterase at synapses results in accumulation of acetylcholine
and overactivation of acetylcholine receptors at the neuromuscular junction and in the
autonomic and central nervous systems.4
It is important to know the pattern of poisoning in a particular given region. This will help in
early diagnosis, management of poisoning, which will result in the reduction of morbidity
and mortality rates.5
In recent years, there has been increasing public concern about the safety of chemicals of all
types, pesticides are an important class of chemicals to which everybody is exposed to some
extent6.
Informing the general public, as well as special groups at risk, about recognized or emerging
risks to the community posed by the use, transport, storage and disposal of specific chemicals
and giving guidance on how to avoid exposure to, or accidents with these substances; by
means such as brochures, leaflets, posters, educational programmes, and campaigns in the
media may be employed.7
The World Health Organization (WHO) estimates that globally three million intentional and
unintentional pesticide poisoning episodes occur annually and, of these, a minimum of 300
000 die, with 99% of the cases being from low and middle income countries.8
Indian Scenario
The importance of pesticides in India can be understood from the fact that agriculture is a
major component of the Indian economy and is the livelihood of nearly 70% the country’s
workforce. 9
There is continuous increase of pesticide suicide rates in India. According to the national
Crime Records Bureau in India, in the five years prior to 2001, there were on average 15,750
reported farmer suicides a year on average.10
A huge number of chemical substances available in the market and they are mainly to save
the agriculture products. The poison may happen through the household products,
occupational and accidental.11
Role of poison information centres in toxicovigilance and prevention of poisoning would
add weight to the prevention actions instituted by centres and make it easier for a centres to
obtain complete data on the composition of toxic and potentially toxic products.Legislative
authorities should seek the recommendations and advice of poison information centres
concerning control measures and legislation to prevent poisoning9.
The present day human being lives in a chemical environment. Pollution has paralleled the
technological advances. The massive expansion in the availability and use of chemicals,
including pharmaceuticals, during the past few decades, has led to increasing risks to human
health posed by exposure to these chemicals12.
In some instances, people subject to massive fatal exposure through chemical disaster
or in isolated accidental or intentional poisoning. Special programmes for control and
facilities for the diagnosis, treatment, prevention of poisoning and toxicovigillance are
urgently required in health care delivery13.
But unfortunately there is no poison information centre available in and around the Gulbarga
District. Gulbarga, being and important agricultural district, poisoning from agrochemicals
substances is very common in this region. Easy availability of poisons plays a very important
and crucial role in both accidental and suicidal poisoning. Factors contributing to accidental
poisoning are, lack of health education, poverty, lack of knowledge of toxic effects of these
compounds, because of poor socioeconomic status, these are stored in house and kept within
the reach of children, may causes the accidental poisoning. The present study was undertaken
with an objective of finding the socio-demographic factors and knowledge regarding
precautions and safe use of pesticides among the rural public in Gulbarga. The study also
intends to educate the symptoms, first aid measures of organophophorus poisoning. The study
aims to focus upon the education for creating awareness in handling of organophosphorus
poisoning among the agriculture population in Farthabad village in Gulbarga.
METHODOLOGY
This is an educational interventional study to assess the baseline data of knowledge of
rural public, particularly agricultural farmers, followed by intensive educational season
regarding safe use of pesticide and first aid measures to be taken in case of emergencies such
as occupational, suicidal, accidental poisoning etc.
Farthabad is a Village in Gulbarga Taluk in Gulbarga District. The distance from Bangalore
is 492 km. According to the 2011census it has a population of about 11000.
The weather in Farthabad consists of three main seasons, temperatures during the
different seasons are, in summer 36-44 0C, in rainy season 27-370C and in Winter 11260C.The annual rainfall was about 770 mm.
Major crops include Bajra, Toor, Sugar Cane, Ground Nut, Sun Flower, Sesames, castor Oil
,Beans, Black gram, Jawar, Wheat ,Cotton and linseed. Majority of the population rely on
agriculture as a source of their livelihood. During the survey this village was found suitable
as 70% of the population are engaged in agricultural activities with cultivable land. The
Study was carried out form June 2012 to march 2013. It is a prospective educational
interventional study
Agricultural farmers / Labours aged above 18 years of either sex, the farmers, labours and
local adult population who are willing to participate in the study, farmers who are not highly
educated were included in the study.
Farmers/ labours below the age of 18 years, farmers who are not willing to participate in the
study,farmers with high income group were excluded from the study.
Study Procedure:
The study was carried out as per approved protocol by the institutional ethical
committee MRMC, Gulbarga (HKES/MRMCG/23/11/26/2012-13).
A total of 180 farmers were selected for the study, out of which 150 were completed
the study, 30 farmers didn't turn-up for the follow ups. The data of only those farmers
who have completed the study were analysed.
At baseline the farmers demographic details (age, sex, marital status, educational status,
occupation, economic status, number of cultivable land in acres) was collected in a data
collection form and the basic knowledge regarding OP-poisoning was assessed by
administering the pre-tested oral questionnaires by which their baseline knowledge is
collected in the form of scores. After that the farmers were educated with the help of
pictogram and lectures regarding storage, handling (before and after spray) and first aid
measures to be taken in case of OP-poisoning ,in several sessions.
On first follow-up ,again the farmers knowledge score were assessed by administering the
pre-tested questionnaires and further educated them with the help of Teaching aids such
as leaflets, pictogram, lectures and LCD slides.
On second follow-up the farmers were reassessed by administering Same questionnaires.
The data collected from the follow ups were analysed using suitable method. Scoring was
evaluated in terms of percentage for interpreting the difference between pre and post
interventions.
The first study during May-2012, meeting was conducted in farthabad village with
Gram Panchayat Officials, local political leaders and prominent persons were assembled
and discussed the need for such program and motivate them to cooperate to conducting
the educational activities.
Subsequently, the village is visited several times and several meetings were conducted
with local social workers, youth organization and individual people and discussed several
issues, which include mainly location of the study and recruitment of appropriate study
subjects.
Preparation for Study: During the study government authorities such as joint director of
agricultural office Gulbarga and local agricultural information centers were met and
collected information regarding details about the organophosphorus poisoning,
programmes, posters, education etc.
The agrochemical shops in the Gulbarga city were surveyed and literatures, poison
information materials were collected.
Information about antidotes, literatures, precaution and other safety measures were collected
from the selected fertilizer industries.
A brief questionnaire were developed to test base line information of knowledge
regarding poison and to tested for its validity before intervention. Scoring (one point) was
given to each question answered correctly and total score was compared between before and
after intervention. The same questionnaire is retained to take information after the
intervention.
Before educational program is initiated people were informed through an appropriate
local media such as announcement, public notice and banner with the date, time and venue of
conducting program were emphasized.
Information leaflets were developed in English and Kannada were used to educate the
local public.
Education was given through the multimedia in local language during AugustSeptember 2012, containing general information about the poison, pesticides, precautions to
be taken while handling the poison and several pictograms were used and explained in local
languages.During the education the participants were interacted and discussed about the
various aspects to improve the knowledge, the doubts were cleared. The public and study
subjects were actively participated in the programme.
STATISTICAL ANALYSIS:
Data was statistically analyzed using students‘t’ test wherever applicable for
significance of the result. Also the scoring was evaluated and presented in terms of
percentage for interpreting the difference between before (Pre) and after (post) intervention.
REUSLTS
During educational interventional study, the interviews were conducted to the 150
individuals of randomly selected farmers who attended the program at Farthabad village of
Gulbarga District. The age group criteria were between 18 years and above of age and the
minimum age were 18 years and maximum was 82 years of age. From the demographic data
presented in table (Table 1), among the total number of individuals, 124 were male and 26
were female considered as study subjects. The demographic data reveals that married persons
123 and unmarried persons 27(Table 2). The education level of study subjects was found to
be primary school 80, matriculation 25 and 18 were graduates followed by 27 were illiterates
shown in (Table 3). In the study subjects, farmers were (78) and labours were (72). It was
found that maximum numbers of study subjects were from Group-1 (111) and group-2 (39)
and no study subjects belonged to group-3 (Table 4). Among the total study subjects in
relation to per capita land holding, highest number (136) are found in the group, nil to up to 2
acres shown in (Table-5).
Development of Educational Materials:
Since the most of the populations were found to be illiterate and less educated it was
aimed to develop and distribute educational materials such as leaflets, postures, pictograms as
simple as possible, so that the rural people could understand without difficulty.
The following are the main educational tools used.
1. The leaflets of English/Kannada language.
2. Questionnaires in English/Kannada language.
3. Multimedia presentation in English/Kannada.
4. Group discussion
5. Role play
The public supports to the educational program were overwhelming and most were eager to
seek information about insecticidal poisoning and related issues. At the time of program
around 180 people were attended the venue. We have selected only 150 subjects who
satisfied out inclusion criteria such as they should be actively involved in one or any form of
agricultural activities. A specially prepared oral questionnaire was administered to collect the
baseline knowledge. The baseline knowledge collected in the form of scores which signifies
their degree of knowledge.
The information was collected under the following headings:
1. Storage:
At the baseline 152 (47.50%) scores were awarded out of maximum 320. After the
intensive educational intervention program the scores of knowledge increased to 289
(90.32%). There was a difference of 44.70% change observed which was statistically highly
significant (p<0.0001).
2. Handling before spray: The results revealed that there were only 124 scores out
of maximum 240 (51.66%). Again the same variables were measured following
educational programmes, it was found that 220 scores obtained by the study
subjects (91.66%) group. There was difference of 45.82%. This difference is
statistically highly significant (p<0.0001).
3. Handling after spray:
The results showed that at baseline 157 (49.06%) scores were awarded out of
maximum score of 320. After the intensive educational intervention program the
scores of knowledge increased to 290 (90.62%) There was a difference of about
44.68%, is observe, which is statistically significant (p<0.0001).
4. Organophosphorus Poisoning:
The results revealed, that before intervention 121 (21.60%) scored were awarded out
of maximum 560. After intervention the scores of knowledge was improved to 505
(90.18%). The total difference was 68.58% (p<0.001).Which is statistically
significant.
5. First Aid:
The results showed that study subjects were asked whether they know first aid
measures to be taken in case of poisoning through inhalation, contact with skin
and if swallowed. There were only 52 (21.66%) scores out of maximum 240.
again the same variables were measured following post-educational program. It
was found that 218 (90.84%) scores obtained by the study subjects. There was a
difference of 69.18%. This difference is statistically highly significant (p<0.0001).
Discussion
Indian economy is mainly depends on agriculture, most of the people earn their livelihood
with the main occupation of agricultural activities. In this scenario as more and more
scientific technology advances, farmers are increasingly being adopted modern agriculture
technology to get maximum yield. Use of organophosphorus pesticides is one of the main
scientific strategies which replacing traditional agriculture practice. Such a large-scale
utilization of agrochemicals will invariably leads to increase incidence of poison related
illnesses, since agrochemicals are highly toxic. This complication may be augmented and
other epidemiological factors such as illiteracy, ignorance and lack of education.
Thus in epidemiological study of organophsophorus poisoning (one of the important
agrochemical) in the hospital and as well as community revealed that majority of morbidity
and mortality mainly determined by lack of adequate knowledge regarding usage, storage,
handling and first aid measures. Hence it is obvious influencing these by effective health
education intervention could probably lessen the disease burden associated with poisoning.
In this prospective study the education intervention directed to the farmers and
agriculture labours of Farthabad village of Gulbarga city. The five aspects of knowledge, they
are: storage, handling before spray, handling after spray, organophosphorus poisoning and
first aid measures was studied. The results revealed that there was significant improvement in
the knowledge scores after the educational intervention, which is statistically (p <0.0001)
highly significant. The conclusion can be drawn that there is an increase in the need of
agrochemical poisoning related information among the agricultural workers in Farthabad
village of Gulbarga district. Appropriate educational programmes to increase the knowledge
among rural public is of prime importance, which not only helps to develop healthy lifestyles
in handling, storage, using of agrochemical poisons, but also helps to give first aid measures
in case of accidental/ occupational poisoning.
CONCLUSION
Poisoning by agrochemicals is an important medical emergency which causes a high
morbidity and mortality requiring immediate medical attention.
In the present work it was found that a significant outcome of assessment and education in
community and which was well pronounced in all the data of pre-intervention and postintervention etc. Excessive use of Organophosphorus pesticides for agricultural purposes
were intentional to harm not only our agriculture production but it’s directly and indirectly
affect to common people, due to easy availability in India. Hence strict rules must be
followed regarding sale of pesticides mainly in adolescent. Interventions directed towards
health education, counselling, must be initiated to prevent further complications of OP
poisoning and enforcement of laws restricting the availability and use of harmful pesticides
must me strengthened.
In this prospective study the limitations are limited to a particular area namely Farthabad
village of Gulbarga. The study needs to be replicated in other geographical areas and with
larger sample sizes in order to confirm the universality of the findings generated.
ACKNOWLEDGEMENT
We are thankful to all the faculty members of Department of Pharmacy Practice, BTGH,
HKES, MTRIPS, Gulbarga, for their valuable guidance. We extend our heartfelt thankfulness
to all the farmers of Farthabad village, Gulbarga for their participation and support to
complete this work.
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Forensic Med C 33, Vol No. 2, 2011.
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6. WHO Technical Series. Safe use of pesticides. 4th Report of the WHO Expert Committee
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Hospital Today 2002; 7(11) p.598-601.
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TABLES
Table No. 1: Gender and Age of study subjects
Gender
Total study subjects (150)
Male
124
Female
26
Age
No. of study subjects (150)
15-24
23
25-34
24
35-44
42
45-54
26
55 >
35
Table No. 2: Marital status of study subjects
Marital status
No. of study subjects (150)
Married
127
Unmarried
23
Table No. 3: Educational status of study subjects
Educational status
No. of study subjects (150)
Illiterate
27
Primary school
80
Matric
25
Degree/Above degree
18
Table No. 4: Economic status of study subjects
Class
No. of study subjects (150)
Lower (Group-1)
111
Medium (Group-2)
39
Upper (Group-3)
Nil
Table No. 5: No. of cultivable land in acres of study subjects
Land in acres
No. of study subjects (150)
1 acre
52
>2 acres
47
>5 acres
19
>10 acres
14
Nil
15
Table No. 6: Assessment of Knowledge Before and After Intervention
Parameters
Storage
Handling
before spray
Handling after
spray
OP-Poisoning
First Aid
No. of Points
Scored
% Difference
Pre
intvn.
Post
intvn.
Pre
intvn.
Post
intvn.
Highly
Significant
320
152
289
47.50
90.32
Highly
Significant
240
124
220
51.66
91.66
Highly
Significant
320
157
290
49.06
90.62
Highly
Significant
560
121
505
21.60
90.18
Highly
Significant
240
52
218
21.66
90.84
Highly
Significant
Max. Scores
Level of
Significance
FIGURES
LEGENDS
Table No. 1: Gender and Age of study subjects
Table No. 2: Marital status of study subjects
Table No. 3: Educational status of study subjects
Table No. 4: Economic status of study subjects
Table No. 5: No. of cultivable land in acres of study subjects
Table No. 6: Assessment of Knowledge Before and After Intervention
LEGENDS
Figure No 1: Graph Showing Distribution of Study Subjects According to Different Age
Groups
Figure No.2: Graph Showing Change in the Knowledge Scores Observed in the Study (before
and after intervention)
Figure No. 3: Graph Showing % Increase in Knowledge of Various Parameters Studied
Following Educational Intervention