SUMMARY OF FARMER HEALTH STUDIES
Presented at the
Agricultural Workers and Farmers:
Conference on Health Effects of Pesticides
Sponsored by
Pesticides Action Network in Asia (PAN-AP)
And
Food and Agriculture Organization of the United Nations Programme
(UN/FAO) for Community Integrated Pest Management (CIPM) in Asia
Tanjung Bungah Beach Hotel
Penang, Malaysia
18-20 March, 2002
Helen H. Murphy, Epidemiologist
Community Health Consultant
Food and Agriculture Organization of the United Nations Programme (UN/FAO)
for Community Integrated Pest Management (CIPM) in Asia
May 2002
Introduction
Since 1999, the Community Integrated Pest Management (CIPM) Programme in Asia has
added a health component to the Farmer Field School curriculums. Farmers conduct their
own studies on the hazards and adverse human health effects of pesticides. Through this,
they reach a greater understanding that their own health is a vital part of the ecologic
cycle.
Five CIPM countries have conducted studies within their programs. They have either
been cross sectional (one time observational surveys in Cambodia, Vietnam, Indonesia,
Thailand) or longitudinal (multiple reporting over time in Vietnam and Sri Lanka).
Others (Cambodia) have been simple recall surveys on what occurred over farmers’ last
cropping season within a farmer field school. In Thailand, school children have
conducted the studies by gathering information from their farming parents or neighbors.
The primary purpose of these studies is to i) educate farmers, ii) encourage alternative
means to control pest and plant diseases through IPM and iii) to discourage farmers from
returning to pesticides after IPM. Beyond this, a few countries have used these health
studies for program purposes. Vietnam used them as an evaluation tool. They conducted
a large survey in three provinces where they planned to implement CIPM. It is being
repeated again among the same respondents to measure the impact of CIPM after two
years. Cambodia conducted a large survey in 1999 to assess the situation of pesticide use
before starting their health component. Thailand used their surveys in schools that have
an IPM program as a means to educate the community. The longitudinal studies in Sri
Lanka and Vietnam were pilots to test a farmer self-surveillance system in order to
estimate the number of unreported cases of pesticide poisoning not seen by the health
care system. Self-inventory surveys are conducted among farmer participants at the
beginning of their farmer field schools in Cambodia. This serves to motivate fuller season
long participation.
This report summarizes the findings of these CIPM studies. Another two studies from the
region that were not within an IPM context are also included, one from Malaysia and
another from Philippines. They were all presented at the “Agricultural Workers and
Farmers: Conference on Health Effects of Pesticides”. It was sponsored by Pesticides
Action Network in Asia (PAN-AP) and the Food and Agriculture Organization of the
United Nations Programme (UN/FAO) for Community Integrated Pest Management
(CIPM) in Asia in Penang, Malaysia March 18-21, 2002. Details of each study are
described in abstracts at the end of this report.
Methods
Cross sectional studies: Eight of the eleven studies summarized here were cross-sectional
in design. 1 Table 1 summarizes the studies in terms of objectives, sample size and details
of data collected. Seven out of the eight used the same methodology as follows:
1
All the cross-sectional studies used the same methodology with the exception of the Philippines, which
was not conducted within the context of CIPM.
2
Through classroom games and exercises farmers and or children learned to gather
information from their pesticide spraying colleagues and or parents on the following
areas:
1. Pesticides used during spray sessions (and during household surveys or in local
pesticide shops) were classified by brand and common name, hazard level, and
chemical family.
2. Quantification of yearly spray frequency, total liters of pesticide solution
exposure, and numbers of pesticides used per tank are calculated.
3. Farmers were observed during spray sessions to identify routes of pesticide
exposure and personal protective equipment (PPE) used during a real spray
session.
4. Farmer households were observed to identify hazardous child, food, water, and
live stock pesticide storage and disposal practices.
5. Farmers were interviewed about health problems related to pesticide use and or
interviewed and examined before, after and 24 hours after a spray session using a
panel of 32 signs and symptoms of pesticide poisoning on a body map form.
The data was then analyzed, summarized and presented back to the respondents and
community in a meeting.
Farmer Self-Reporting Surveillance: Malaysia, Vietnam and Sri Lanka conducted
longitudinal surveillance studies. In Malaysia over a 3-month period, 67 women sprayers
marked down daily on pictorial cards daily any health problems they faced. In Vietnam
and Sri Lanka, non-IPM farmers were randomly selected and asked to participate. Once
they have agreed, they were trained on the
definition of the signs and symptoms through a
variety of classroom exercises and games. They
then practiced self -reporting for a month after
which the process was evaluated for problems. At
this time refresher training was conducted. The Sri
Lanka data represents the findings from this onemonth trial. Thereafter, farmers filled out a singlesheet form that is primarily pictorial (Fig.1) after
each spray session. They circled any the sign or
symptom experienced during or up to 24 hours after
spraying. The Vietnam data represents reporting
over 12 months.
Other written information the farmers filled in
included identifiers such as name, address, date,
gender, pregnancy status if female, number of tanks
used, crops sprayed, and the pesticides used. Any
other symptoms experienced but not on the picture
were added. The numbers of mild, moderate and
severe signs or symptoms (S&S) were totaled as well as the illness category - a mild,
moderate, severe or non- illness event. Weekly the forms were collected and tabulated.
Monthly the data was summarized and graphed for community inspection and discussion.
The local doctor added the number of pesticide poisoning cases seen that month as well.
3
Table 1: Cross Sectional Studies-Objectives and Sample Sizes
Abstract # Study Objective
Sample Size and Data Collected
1. Thai School
Village survey
202: farmers interviewed about:
Children’s Study Child to parent education
- health effects ‘ever experienced’
- amounts of pesticides used
282: households observed
8: spray sessions observed
2. Khmer*Sample survey from 2
31 farmers interviewed about:
CEDAC survey
villages
- pesticides used
- health effects ‘ever experienced’
3. Khmer*Survey of non-IPM farmers
10 farmers:
(FFS) Farmer
as a Farmer Field School
- recall on amounts of pesticides used
Field School
exercise with farmer trainers - each farmer’s house surveyed
and IPM farmers
- each farmer observed during a complete
spray session
-pre and post spray session health exam
4. Khmer*Self inventory among new
31 farmers interviewed in two areas:
DANIDA
farmer field school farmers
-products used last season
Farmer Field
-amounts used
School
-household storage and disposal conditions
-health problems ’ever experienced’
5. Khmer*Situation of pesticide use in
210 vegetable growing farmers were
Situational
Cambodia
interviewed about:
Analysis
-pesticides used and combinations
-spray frequency
-spray conditions
-health effects ‘ever experienced’
6. Vietnam
Baseline survey to measure
480 farmers: 80/village, 2 villages/province,
Baseline
the impact of community
3 provinces
IPM
-pesticides in use
-amounts used last season
-observed each spraying
-pre and post spray session health exam
7. Indonesia
A post farmer field school
60 farmers were interviewed about:
Farmers Study
study with IPM farmer
-pesticides used/tank
interviewers
-spray frequency and amounts used
-observed spray practices
-pesticide storage methods
-health effects ‘ever experienced’
8. Philippines
A survey of previous
88 workers were interviewed about:
IRRI worker
International Rice Research
-work positions/pesticides used
Institute workers’ work
-pre-employment health exams
conditions
-pesticide protection training
-provision and use of PPE
-health complaints
* Khmer = Cambodian
4
Results
1. Reported or Observed Signs and Symptoms of Pesticide Poisoning
Reports or observations from 1,280 farmers are summarized on the below graphic. The
most commonly reported symptoms were headaches (38%) and dizziness (28%). These
are common complaints and while non-specific, can indicate central nervous system
effects from pesticide use. The next most common complaints, excessive salivation and
sweating, exhaustion, and tremors (18%, 15%, 16%, 13% respectively) could be due to
heavy labor or again, neurobehavioral effects. Chest pain and shortness of breathe, both
adverse respiratory effects, occurred at the same rate (12%), which is what we would
physiologically expect. This gives credence to the quality of the data. The same can be
said in regard to nausea and vomiting, both reported close to the same frequency. These
are clear neurotoxic effects, which indicate that pesticide poisoning is indeed occurring
among 10% of farmers who were spraying pesticides. Ataxia (staggering gait) that was
reported by 8%, is another clear indication of pesticide poisoning. Of concern is the 1%
who experienced a serious event, loss of consciousness and or seizures. (Figure 1)
Summary of Studies: Signs and Symptoms of Pesticide Poisoning
n=1280
Seizure
Loss of consciousness
Tearing
Diarrhea
Muscle cramps
Insomnia
Burning nose
Numbness
Stomach cramps
Cough
Staggering
Runny nose
Skin rash
Sore throat
Eyelid twitching
Nausea
Muscle weakness
Vomiting
Blurred vision
Shortness of breath
Chest pain
Itchy skin
Tremor
Eye irritation
Red eyes
Salivation
Exhaustion
Sweating
Dizzy
Headache
0
5
10
15
20
25
30
35
40
% sample w/observed or reported sign or symptom
The health complaints of the IIRI workers in the Philippines are not included in the above
summary because the adverse effect frequencies per study respondent were not reported.
But 63% of the sample recalled some adverse health effect related to their work with
pesticides. The complaints included: skin irritation, dizziness, cough, ‘soggy eyes’
(excessive tearing), numbness, severe headaches, ‘motion sickness’ (nausea or
giddiness), tremors, vomiting and chest pain.
5
Table 2. Regional Summary Of The Signs And Symptoms Of Pesticide Poisoning
Severity % Signs
Thai
VN Khmer* Khmer* Khmer Indo Sri Lanka VN Malaysia Khmer* ALL
Score and Symptoms
School Baseline CEDAC DANIDA FFS nesia 1 month 12 month Women Sit Anal
1,2,3 n = sample size
n =149 n =480 n =31 n =30 n=10 n =60 n =193 n =50 n =67 n =210 1280
1 Insomnia
2
0
0
0
17
21
6
5
1 Red eyes
31
0
60
0
28
19
7
14
7
1 Eye irritation
16
0
100
37
28
16
7
7
14
2
7
1 Tearing
7
39.5
0
0
6
15
4
0.6
1 Runny nose
5
39
35
17
6
19
9
9
6.5
1 Salivation
9
59
80
32
6
24
28
15
6
7
1 Burning nose
8
0
50
17
8
17
6
7
2
1 Dizzy
34
83
100
48
31
27
9
50.5 28
7
1 Sore throat
2
37
50
7
20
22
3
10
5
7
1 Cough
5
0
65
17
7
14
9
8
4
4
1 Numbness
11
58.5
35
22
0
7
4
7
3
1 Itchy skin
17
52
0
32
15
27
13
12
1 Sweating
14
39
100
46
13
4
38
18
7
1 Skin rash
23
0
45
37
7
3
8
5
9
3
5
1 Muscle weakness
27
42
65
6
6
11
10
1 Shortness of breath
6
54
65
0.3
10
5
2
38
12
0.4
1 Headache
30
80
75
43
48
51
13
49
38
26
7
1 Exhaustion
15
35
25
13
43
16
2 Blurred vision
15
49.5
85
18
11
16
5
2
11
6
4
2 Eyelid twitching
13
49
100
12
9
3
1.4
10
6
2 Vomiting
11
25.5
75
8
2
1
1
35
11
0.4
4
2 Chest pain
3
58
50
25
4
14
4
16
12
10
2 Nausea
6
49
100
35
6
7
3
11
10
2
2 Stomach cramps
2
51
80
18
8
1
10
7
0.8
2 Diarrhea
4
0
100
13
0
1
4
4
0
2 Staggering
25
37
50
27
3
0
4
8
2
2 Muscle cramps
5
0
35
12
9
2
4
2
2 Tremor
36
0
75
50
10
3
2
4
13
6
3 Convulsion/seizure
0
0
20
2
0.5
0
1
1
0
3 Loss of consciousness
1
0
5
3
1
0
5
1
0
Others:
Missing nails
3
0.4
Sleep disturbance
7
1
Cold/sweaty extremities at
night
23
4
Nosebleeds
1
0.1
* Khmer = Cambodian. Bolded columns=observed pre and post spray session health effects
The data from the Vietnamese baseline study and the Cambodian FFS was derived from actual
observations pre and post spray operation. The Sri Lankan one month and Vietnam 12 month studies
were self-reports during and up to 24 hours after 524 and 1,798 spray operations, respectively.
Using vomiting as a clear determinant of pesticide poisoning, Cambodia had the highest rates in the
region, 25.5% to 75%. Similarly they reported the most severe episodes. One to 5 percent reported and
6
episode of loss of consciousness and up to 20% (CEDAC) reporting a seizure at some point in the past
associated to spraying.
2. Use of Hazardous Pesticide Products and Mixing More than One Product Together
Consistent with higher rates of pesticide poisoning, 52% to 65% of Cambodian farmers used a pesticide
that is either extreme or highly toxic to human health. Vietnam and Thailand were also big users.
Indonesia, that has made efforts to ban these products, used less (10%). 44-47% of IIRI workers in the
Philippines were using highly hazardous products (Ib), monochrotophos and carbofuran. Only a few
farmers in Sri Lanka still use Ib products because the country has banned all pesticides in this class I
category.
Table 3. Use of Class I (Extreme and Highly Hazardous) Pesticides and Mixtures/Tank
Study
Country
n
%I
mix >3
Thai
School
202
31%
VN
Baseline
480
41%
VN
12 month
50
20%
27%
Khmer*
CEDAC
31
65%
Khmer*
Sit Anal
210
10%
100%
Indonesia
IPM farmers
60
10%
78%
Sri Lanka
1 month
193
0.6%
3.5%
Philippines
IIRI workers
88
44-47%
Of the available data on mixing more than one product together in a tank, Sri Lankans rarely used
multiple pesticides together in spray operations. It was the norm among the Cambodian study sample
and also common practice in Indonesia. This practice is a not only a risk factor for pesticide poisoning
but also very harmful for field ecology
3. Amount of exposure. Estimating spray days and the amount of pesticide solution applied per year is
used in these farmer studies as a means to roughly estimate and compare yearly exposure between
countries. The most accurate method is to have farmers self report the number of tanks they used after
each spray operation. Although perhaps coincidental, the Sir Lankan and Vietnamese used remarkably
similar amounts. Looking at averages, farmers are heavily exposed to pesticides 47 days a year, using
approximately 2,77 liters of solution. Cambodians again used the highest amounts at 3,400 to 7,000 liters.
Table 4. Amount Of Pesticide Exposure
Country Study
Study
Average spray days/farmer/year
Average liters/farmer/year
Thai school
School
282
60
1,916
VN baseline
Baseline
480
59
692.4
Khmer* FFS
FFS
10
no data
7,000
Khmer* CEDAC
Sample size
DANIDA
30
no data
3,400
Sri Lanka 1 month surveillance
1 month
193
33
1,832
VN surveillance
12 month
50
36
1,833
47
2,779
Regional average
7
4. Use of Personal Protective Equipment (PPE)
Most farmers were aware of what equipment should be used to protect themselves from exposure. But
looking at practice realities, few used the recommended gear. Even when provided, only 24% of IIRI
workers in the Philippines used masks or respirators or gloves, 12% protective clothing and 17% eye
protection. The below graphic is a summary from all the farmer surveys that had known sample sizes.
Personal Protective Equipment (PPE) Data Summary (n=1067)
hats 69%
goggles 7%
masks 36%
wet 98%
long sleeves 56%
gloves 4%
long skirt/pants 57%
wet 98%
rubber boots 10%
wet 91%
Only hats long sleeves and long pants were common practice, more likely for sun protection. Goggles,
gloves and boots were only used in 10% or less of the farmer respondents. Almost all farmers at the end
of their spray operation were soaked with solution.
5. Routes of Contamination
The most common route of exposure was through the skin, either through mixing, wet clothing or the
spray wand. All studies reported that farmer’s hands were wet after completing the spray operation. Most
hazardous is direct oral contact. This was observed in 1% to 15% of the respondents. Smoking during
the spray operation was noted in 35% of the farmers in Indonesia and eating in all the Thai respondents.
Because the hands are contaminated with pesticides, this is a hazardous route of oral exposure.
Exposure During Spraying
spraying up
wind 50% (Indo)
Smoking
35%
(Indo)
leaking tank
75% (Thai)
pesticide
on hands
(100%)
wet back
100%
(Thai-Indo
8
Table 5. Exposure Hazards During Spraying
Country
Study
Thai Vietnam
School Baseline
n=sample size
Respiratory
 sprays upwind
 walks into others mist
Oral
 blows out wand
 smokes while spraying
 eats during work
Skin
 leaking tank
 wet clothes
n =8
n =480
100%
31%
31%
100%
100%
25%
100%
100%
75%
100%
Khmer*
FFS
n =40
Indonesia
Farmer
Study
Khmer*
Situational
Analysis
Philippines
IIRI
Workers
n =60
n =210
n=88
18%
45%
35%
15%
35%
30%
100%
45%
100%
50%
50%
1%
1%
1%
20%
10%
10%
20%
30%
30%
47%
47%
18%
6. Hazardous Pesticide Storage and Disposal Practices in the Household
Throughout the region, pesticide storage and disposal was hazardous, putting family members at risk.
Water was potentially contaminated through improper storage (42%) and disposal (56%). Over half the
households were possibly contaminating their food supplies and three quarters, their livestock. Of
greatest concern was the proportion of households whose pesticide storage and disposal methods were
not child safe; 74% and 59% respectively. Details by country are described in Table 5.
SUMMARY OF HOUSEHOLD PESTICIDE STORAGE AND DISPOSAL PRACTICES
Storage
Disposal
Hazard to:
Water
42%
56%
53%
54%
75%
74%
74%
59%
Food
Animal
Child
9
Table 6. . Household Pesticide Storage And Disposal Practices
Country
Thai
Vietnam
Khmer*
Khmer*
Study
School
Baseline
FFS
DANIDA
n=sample size
n =282
n =480
n =10
n =30
STORAGE
Child unsafe
100%
54%
80%
100%
Food safe
42%
44%
60%
70%
Water unsafe
16%
36%
40%
70%
Animal unsafe
56%
74%
100%
DISPOSAL
Child unsafe
38%
100%
100%
Food unsafe
33%
100%
Water unsafe
33%
100%
100%
Animal unsafe
60%
100%
100%
Khmer*
Sit Analysis
n =210
Indonesia
Farmer
n =60
100%
100%
100%
100%
3%
9%
3%
70%
100%
100%
100%
100%
* Khmer=Cambodian
Discussion
These farmer-generated studies give one a general overview on the situation of pesticide handling and the
kind of acute health problems farmer face in Asia. While inferences cannot necessarily be made to the
general farmer population, most of the data are consistent with what we know from other formal studies.
It also likely better reflects reality because the more knowledgeable stakeholders (farmers) are generating
the data. To summarize the data highlights:
 Highly toxic pesticides pose a serious threat to small landholding farmers, because they cannot be
used safely under these hot humid conditions in Asia.
 The families of farmers are also likely being unduly exposed to pesticides through unsafe storage and
disposal of these chemical products. Over half the food and water supplies were potentially
contaminated and three quarters of their children and livestock are at risk of exposure.
 Approximately 10% of farmers suffered moderate pesticide poisoning through the application of
pesticides and 1% experienced a serious event.
 Dermal skin contact was extensive with an average of 2,779 liters of solution used per year.
 Within the region, pesticides pose the greatest potential public health problem in Cambodia because
these farmers use the largest amounts of multiple mixed toxic products and suffer more serious
adverse effects.
These studies have the advantage of being a low cost means to assess the situation of pesticide use while
at the same time, farmers benefit by gaining a better experiential understanding of the problem. But this
process must remain in the context of IPM or other programs because once awareness is raised, an
alternative to pesticides must be available. Without this, there is little likelihood that these studies will
have an impact on farmers’ pesticide using practices.
Given the information we have, what further steps need to be taken? First and foremost, we need to
evaluate the impact doing these studies has on the individual farmer. Does it in fact dissuade continued
pesticide use? Does it encourage use of alternative means to control plant disease and pests? Or will these
farmers simply hire out spraying to contract workers? These questions need to be answered by further
farmer studies that are expanded to measure impacts.
10
Another direction we need to take is sharing this information with the health sector at local, national and
international levels. Ministries of Health often have other urgent health priorities such as infection
disease epidemics (HIV AIDS, malaria, tuberculosis) that use up their limited budgets. Therefore, an
environmental health issue such as this often takes a back seat because it is not necessarily associated to
immediate high death rates. The farmer community thus has to keep this emerging public health problem
on the health sector’s radar screen. Because the medical community has no vested interests in the agro
chemical industry and is concerned with the health of their population, they can serve as strong advocates
against indiscriminate pesticide use. With better information from farmers, public health authorities can
push Ministries of Agriculture to develop pesticide policies that better protect farmers’ health.
Within the farming sector, the information also needs better dissemination as well. Usually farming
communities do not hear about the studies conducted on the health effects of pesticides in their own
countries or elsewhere. Nor have there been conferences such as this that bring together farmers who
have done research on this topic. A mechanism needs to be developed to keep farmers aware of new
findings on the hazards of pesticide use so they, as communities, can make better informed decisions on
future pesticide use. The IPM and PAN network offer such an avenue for information sharing.
Recommendations
 A means to evaluate the impact that conducting farmer studies have on the individual farmer should
be imbedded in the design of future studies.
 These study results need to be disseminated to the local, national and international medical
community.
 Where feasible, medical staff should be involved and collaborate with future farmer studies (but not
take over).
 A network through PANAP and UN/FAO–CIPM should be developed through Internet
communications to keep farmer communities informed on each other’s studies, new findings and
published research on the health effects of pesticides.
 Similar study methodologies should be used for community/farmer-based studies so the results can
be compared between countries.
 Farming communities should inform local health authorities of problems so that a Pesticide Quick
Response Service Team (PQRST) – a pool of experts to determine and monitor extent of pesticide
issues and cases- can respond accordingly.
 More farmer communities in other countries should conduct studies such as these to develop a better
picture of the problem of pesticide use in Asia.
 The decisions and action plans (advocacy campaigns, IPM programs, etc) that communities develop
as a result of their health studies need to be supported.
 Farmers and agriculture workers need to be supported in their campaigns to hold agro chemical
companies and other agricultural industries accountable for their health problems.
11
List of Summarized Studies
Cross-Sectional
1. Thailand: “Ban Pa Thorn School Children’s Studies on the Health Effects of Pesticides”. Mrs.
Pornphan Namrat and Mr. Mongkon Tianponkrang . Thai Education Foundation. Bangkok:
February 2002.
2. Cambodia: “Pesticide Monitoring in Community” Keam Makarady and Lang Seng Horng
CEDAC. Phnom Penh. February, 2002.
3. Cambodia: “A Survey on the Health Effects of Pesticides Survey as Part of a Farmer Field
School Exercise in Cambodia”. Ang Soa Yan, Kouk Keuk and Say San, IPM Farmer Trainer,
FAO Community IPM, Phnom Penh, Cambodia, August-September 2001.
4. Cambodia: “Health Survey Exercises in Rice and Vegetable Farmer Field Schools.” Pan Davy.
DANIDA. Phnom Penh. February, 2002.
5. Cambodia Situational Analysis: “Farmers’ Awareness and Perceptions of the Effect of
Pesticides on Their Health”. Sodavy Pan and Sitha Mam.. FAO Community Integrated Pest
Management Program, Phnom Penh: April 200.
6. Vietnam: “Farmer-to-Farmer Studies on Exposure and the Health Effects of Pesticides As a
Baseline to Measure the Impact of Community Integrated Pest Management”. Mr. Nguyen Duy
Hong and Mr. Bui Van Huyen and Mr. Nguyen Phung Hoan . Vietnam National IPM Programme,
Hanoi: March, 2001.
7. Indonesia: “Health Study by Farmers In Pacet, East Java” Heru Setyoko and Nugroho
Wienarto. FAO Community IPM Indonesia. Jakarta. March 1999.
8. The Philippines: “Initial Results of Community Health Monitoring Activities at IRRI” Romeo F.
Quijano. PAN Philippines, IOHSAD, PAN Asia-Pacific. Philippines. March, 2002.
Longitudinal- Surveillance
9. Sri Lanka: “Farmer Self –Surveillance of Pesticide Poisoning Episodes: A Report on a One
Month Pilot.” Mr. Subhash Rathnaweera and Ven. Pannananda. Community Education Centre
and the Office of Registrar of Pesticides. Kandy. February, 2002.
10. Vietnam: “Farmer 12 Month Self-Surveillance of Pesticide Poisoning” Nguyen Phing Hoan.
Vietnam National IPM Program. Hanoi. November 2001.
11. Malaysia: “Poisoned and Silenced. A Study of Pesticide Poisoning in the Plantations.”
Tenaganita and Pesticide Action Network (PAN) Asia and the Pacific. March 2002.
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ABSTRACT 1. Thai School Children’s Study
Thailand: “Ban Pa Thorn School Children’s Studies on the Health Effects of Pesticides”. Mrs.
Pornphan Namrat and Mr. Mongkon Tianponkrang . Thai Education Foundation. Bangkok: February
2002.
Objectives:
This was a discovery learning student project that aimed to :
(i) Increase students and parents’ understanding of the problem of pesticides
(ii) Strengthen student’s skills in critical thinking, math, science, art, teamwork and communication
through an experiential learning exercise
(iii) Document the situation of pesticide use and its human health effects within the student’s community
and
(iv) Encourage the community to reduce their dependence on pesticides and promote alternatives.
Site:
The study was conducted in the two villages where the students of Ban Thorn School live - Ban Pa Thorn
and Ban Pa Lan in Mae Suay district, Chaing Rai Province. The school was one of eleven IPM schools
whose teachers had been trained on how to conduct studies on the health effects of pesticides with school
children during May 2000, September 2000, and May 2001. Ban Thorn School is a small primary school
with 204 students and 10 teachers. The surrounding agriculture communities are large producers of rice,
corn, cabbage, eggplant, chili and ginger.
Methods:
The study was conducted by twenty-eight school children (12-13 years old) as part of their 6th grade
science class. Every Friday, 3-4 hours were devoted to the study content, data collection methods, and
analysis. There were 5 study components that included investigating:
(i) Household pesticide storage and disposal practices
(ii) What pesticides (classified by chemical family and health hazard level were in use I
(iii) Yearly pesticide use estimates
(iv) Conditions of exposure and
(v) The signs and symptoms of pesticide poisoning.
Divided into teams of 3-4, students first surveyed and mapped their entire communities to identify
pesticide- using farmers. They then collected the data by observing and interviewing 20-60 farmers
(total 202) and the households (total 282) per team. They analyzed and summarized the data for a
community presentation as well as wrote case- study essays that were shared with their parents.
Results:
The students found 13 different pesticide products in their community of which close to a third (31%) are
class Ia/Ib (extreme and highly hazardous). These were methyl parathion, alachlor, methamidophos and
methomyl. Another 31% were class II (moderately hazardous) to include highly poisonous paraquat and
the organochlorine endosulfon that is carcinogenic and a possible endocrine disruptor in animals. Among
202 farmers, they used an approximate total of 387,130 liters pesticide solution during the previous year.
That was about 1,916 liters of exposure/farmer/year. The students noticed direct skin contamination when
farmers mixed with bear hands and had wet clothes from leaking tanks. Smoking was a source of oral
contamination. Almost all household- pesticide storage was not child safe and 56% were contaminating
livestock. Food and water were also unsafe in 16-19% of the homes. 149 farmers interviewed for
poisoning. There were 4.9 signs and symptoms of pesticide poisoning (‘ever experienced’ - only a few
13
ABSTRACT 1. Thai School Children’s Study
elicited pre and post spray operation) per farmer, of which 3.6 were mild, 1.3 moderate and 0.01 serious
(2 cases of loss of consciousness). Twenty five percent complained of gait disorders associated to
spraying, 36% of tremors and 11% had vomited.
Discussion:
The study documented that highly hazardous pesticides were resulting in fairly obvious instances of
moderate to severe poisoning (e.g. vomiting and fainting). Requests for alternatives to pesticides by
some farmers reflected their increased awareness of the hazards of pesticide use through the children’s
study. The school felt the study generated a new cooperative spirit between the school and community.
The parents felt they had become the ‘unforgotten learning resource’ for the school. The teacher reported
that the children were enthusiastic, efficient team players. One group alone covered 61 farmers and even
the slowest low literate student found ways to fully participate. As a product of this study, lessons on the
health hazards of pesticides will be added to the normal school curriculum in grades 4,5 and 6. The
school intends to start its own Farmer Field school and training on bio-controls will be added to the
school IPM program to meet the community demands for alternatives to pesticides.
14
ABSTRACT 2. Khmer CEDAC Survey
Cambodia: “Pesticide Monitoring in Community” Keam Makarady and Lang Seng Horng CEDAC.
Phnom Penh. February, 2002.
Objectives:
This study was part of larger project that aims to set up a community database on pesticide use and
poisoning among 10 villages in the Saang and Ponhea Leu districts of Kandal Province. It aims to build
farmers’ capacity to monitor pesticide problems as a means to protect their rights and develop farmerhealth advocacy campaigns in 2003.
Methods:
This survey was conducted during a training session in February 2002. Using a questionnaire, 15 farmers
collected data from 31 pesticide sprayers in 2 villages in the Saang and Ponhea Leu districts. The
interviewers were selected based on their interest as well as their reading and writing abilities. Training
methods included lecture, role-play and data collection exercises.
Results:
The interviewers found 26 different brands of pesticides (20 common/ active ingredients) in use by these
31 farmers. Of concern was the amount of extreme and highly hazardous (Ia and Ib) pesticides in use.
Mevinphos (Ia) and methamidophos (Ib) were used by 65% of the farmers. Methamidophos can cause
long term polyneuropathies/nerve damage. Another 52% used methyl parathion (Ia) and 14%
monocrotophos (Ib). All of these products are either banned or highly restricted in most of the world
because their high toxicity renders them difficult to use safely, especially in developing countries. The
majority of farmers mixed 3 to 4 different pesticide products together. Some farmers mixed up to 10 for a
single spray operation. None of the farmers applied only one product alone. All farmers reported that
they had experienced some sort of poisoning associated to spraying. Farmers reported as average of 12
adverse effects with a minimum 3 and maximum 22 of signs and symptoms. Most commonly reported
were dizziness (84%) and headaches (81%) both of which are somewhat vague and ill – defined but
commonly reported adverse effects. Those more definitive signs and symptoms that clearly demonstrate
pesticide poisoning were also commonly experienced. They included chest pain experienced by 58%,
stomach cramps and tremors (52%), nausea (48%) muscle twitching (48%), ataxia or staggering (35%)
and vomiting (29%). There are signs of probable cholinesterase depression from highly toxic
organophosphates.
Discussion:
Clearly there is significant poisoning occurring as a result of these farmers using the most toxic pesticide
products that exist. It was difficult for both the farmer and the interviewers to identify these pesticides
because they were labeled in foreign languages (Thai and Vietnamese). Therefore they had no idea what
they were using. The investigators reported that the study was educational for both interviewers and the
respondents and raised their awareness of the hazards of the products they were using. The findings will
be reported to the communities, other NGOs and the government as well as published. A CEDAC
sponsored farmer network will be established which will further monitor pesticide use and adverse
effects in the study areas. At completion, a forum will be organized for dialogue among farmers, NGOs
and government staff to discuss the problem of pesticides in Cambodia,
15
ABSTRACT 3. Khmer FFS-Farmer Field School Study
Cambodia: “A Survey on the Health Effects of Pesticides Survey as Part of a Farmer Field School
Exercise in Cambodia”. Ang Soa Yan, Kouk Keuk and Say San, IPM Farmer Trainer, FAO Community
IPM, Phnom Penh, Cambodia, August-September 2001.
Objective:
This survey was conducted to demonstrate to a group of new Farmer Field School (FFS) participants the
prevailing hazardous usage and harmful effects of pesticides.
Site:
It was carried out with a small sample of vegetable growers in Phnom Prasat village, Banteay Meanchay
Province.
Methods:
Three Integrated Pest Management (IPM) graduates of Farmer Field Schools who were Farmer Trainers
carried out the study during the wet season (August-September 2001) with 10 farmers in the community
at the beginning of the season long training. These respondents were selected because they used the
highest amounts of pesticides in the area: 3-6 different chemical products at a time. Together the farmers
trainers and FFS farmers observed pesticide handling and storage, spray practices, and signs of any
potential pesticide poisoning before, after and 24 hours post spray operation. They interviewed the
farmers to determine the amount of pesticide solution used during the previous season and to find out if
they had any potential symptoms of pesticide poisoning pre and post spray operation as well as during 24
hours preceding spraying. The results were hand tabulated, summarized, and then presented back to the
sample of respondents.
Results:
All the farmers used an organophosphate pesticide while half used an organochlorine (DDT). All the
farmers used either class Ia (extremely hazardous) product - mevinphos and methyl parathion – and
another eight used class Ib (highly hazardous) product, methamidophos. The other products in use were
cartap (II-moderately hazardous) and Pestop (unknown common name). Half of these farmers were
mixing 3-4 pesticides together for a single spray operation while the remaining used 5-6 at a time. On
average, they spray 4,600 to 7,500 liters of solution per season. All ten farmers’ arms, back and feet were
soaked in pesticide solution after spraying and none used personal protective equipment (PPE). Only two
had their heads covered or wore long trousers. Containers were not properly disposed, all of which were
left in ponds or in their fields. Household storage was similarly hazardous. Six farmers stored their
pesticides near their kitchens and 8 households had pesticides stored under their houses within reach of
small children. The local minor health effects that were witnessed after spraying included eye, throat, and
skin irritation and coughing (experienced by 7,7,5,and 4 of the farmers respectively). Significant
neurotoxic complaints included excessive salivation (7), blurred vision (4), headache lasting 24 hours (7)
and 4 farmers vomited. The other less frequent complaints included exhaustion, diarrhea, stomach and
muscle cramps. Although the sample size was very small, it was striking that multiple extremely
hazardous products were used, exposure was high and moderate poisoning was occurring.
Discussion:
These results were consistent with other larger studies conducted in Cambodia and highlighted the
critical problem of pesticide use. Although these participating farmers were aware that their use of
pesticides was likely affecting their health, they were alarmed by the nature and extent they
16
ABSTRACT 3. Khmer FFS-Farmer Field School Study
witnessed. They felt this process was more effective than other previous training in understanding
the hazards of pesticide use not only on plant ecology but also on human health. More studies are
planned within the IPM program to generate interest and adherence to IPM strategies, locally and
nationally.
17
ABSTRACT 4. Khmer DANIDA Study
Cambodia: “Health Survey Exercises in Rice and Vegetable Farmer Field Schools.” Pan Davy.
DANIDA. Phnom Penh. February, 2002.
Objectives:
The Cambodian IPM Program added surveys on pesticide use and its health effects to their Farmer Field
Schools (FFS’s) curriculum as a means to: (i) Increase farmers' awareness of the hazard of pesticides use
(ii) Encourage farmers to use the alternative means to control pests and plant diseases
iii) Provide soft data on the state of pesticide-related illness, kinds and amounts of pesticides in use,
severity of exposure, and the condition of pesticide storage and disposal. This paper describes some of
the findings and the impact these health surveys had on rice and vegetable IPM farmers.
Methods:
The health surveys or exercises were introduced in both rice and vegetable FFS’s over three days in the
early weeks of the curriculum. The health effects survey and calculation of yearly amounts of pesticide
use was done in week 3 and 4 while classification of pesticides in use, exposure during spraying and
pesticide storage and disposal was conducted at the end of the FFS. The study sample in all cases were
the new FFS farmers They conducted a self inventory of adverse effects, amounts of pesticide solution
used, how they sprayed, stored and disposed pesticides, and what products they used during their their
last season.
Results:
The rice FFS participants (Svay Rieng Province) used fewer pesticides than their vegetable farmer
counterparts. They sprayed only 2-3 times a season for two annual crops that resulted in a total pesticide
exposure of 640 liters per farmer per year. Nevertheless, 83% reported excessive sweating, 66% muscle
twitching, 60% skin problems and 56% vomited. While they only apply one product at a time, half are
highly hazardous (Ib) products. Household storage and disposal was hazardous and exposure during
spraying high. Farmers were covered in pesticide solution after spraying. Meanwhile, the vegetable FFS
in Bantay Meanchey Province reported proportionally more adverse effects. Although fewer had skin
problems (45%), on average 75% had experienced moderate adverse effects. These included muscle
twitching, diarrhea and excessive sweating (100%), blurred vision (85%), stomach cramps (80%),
tremors and vomiting (75%), chest pain and staggering (50%). Five percent lost consciousness and 20%
had a seizure. These farmers used 5 times more pesticides than their rice farmer counterparts. A typical
farmer used 3,400 liters of pesticide solution per year. Exposure and household storage and disposal
practices were similarly hazardous as the rice farmers.
Discussion:
The impact the self-inventory health exercises had on FFS participation was the most important finding.
During a teacher-training refresher course for district and farmer trainers, those that worked in low
pesticide-using rice areas (Svay Rieng) felt the health exercises should not necessarily be added to the
curriculum. These farmers had not sprayed very often and thus were not impressed with the impacts of
pesticides on their health. Conversely, the vegetable IPM farmers had the opposite reaction. They became
acutely aware of the health hazards of pesticide use and were quite alarmed. While the program will
continue with this health component in both programs, ecology will remain a stronger consideration over
health to encourage rice farmers to reduce pesticide use. But for the vegetable farmers, the health
implications are so serious that conducting these self-surveys should be a critical part of the FFS
program.
18
ABSTRACT 5. Khmer Situational Analysis
Cambodia Situational Analysis: “Farmers’ Awareness and Perceptions of the Effect of Pesticides on
Their Health”. Sodavy Pan and Sitha Mam.. FAO Community Integrated Pest Management Program,
Phnom Penh: April 200.
Objective:
This study was a first attempt in Cambodia to understand the situation of pesticide use and its perceived
health effects among Khmer farmers. The aim was to assess if farmers felt pesticides were affecting their
health or their families, determine what kinds of products they were using, how they handled pesticides,
and what signs and symptoms of poisoning they may have experienced during or shortly after spraying.
The results were used to design appropriate health awareness interventions among farmers.
Sites:
The study was conducted in 3 vegetable growing areas of Cambodia: Kandal, Siem Riep provinces and
farms outside of Phnom Penh.
Methods:
Two apprentices in the FAO/IPM Young Professionals Program conducted the study. They used the
FAO/IPM “Farmer-to-Farmer Health Studies Manual” for the study guidelines. IPM farmer trainers and
IPM farmer graduates helped with the data collection. Two hundred and ten 210 vegetable farmers were
purposively selected for interviews based on the subjects being vegetable farmers as well as routinely
using pesticides to control pests and plant diseases.
Results:
Highly hazardous products that are banned elsewhere in Asia were in use. As classified by World Health
Organization (WHO); 43% were using class Ia products (extremely hazardous), another 9% class Ib
(highly hazardous), and in total, 84% used products from moderate to extremely hazardous to human
health (Ia, Ib, II). Farmers had no idea what they were using as all the labeling was in a foreign language
(Thai or Vietnamese). Furthermore, all information on the use of pesticides came from untrained sourcesneighbors or pesticide sellers. Farmers were exposed to multiple doses on multiple occasions. Crops
were sprayed up to 20 times per season with up to 5 different pesticides mixed together per tank per spray
operation. Few used protective equipment likely resulting in heavy skin contamination to the hands
(during mixing of the chemical concentrate) and legs and feet during spraying. There was evidence that
significant poisoning was occurring as 35% reported a sign (vomiting) reflecting moderate poisoning
during or after spraying. Another 5% reported having a seizure and 1% said they passed out.
Discussion:
Although the data was qualitative and largely anecdotal, it brought to attention the potential serious
nature of pesticide use in Cambodia. It generated heated debate and called for further observational
studies by trained IPM and other NGO staff in their communities. BBC subsequently made the
documentary, “Toxic Trail”, to bring further attention to the problem. Urgent measures were
recommended to keep these hazardous products out of Cambodia through effective bans and restrictions
of those most toxic products, proper labeling and better information dissemination to farmers on the
hazards of indiscriminate pesticide use. The Cambodian IPM program subsequently had been training
farmers entering Farmer Field Schools to conduct health surveys in their communities as a means to help
them become more aware of the hazards of pesticide use. It also motivates them to seek alternatives to
chemical pest control within the IPM context.
19
ABSTRACT 6. Vietnam Baseline Survey
Vietnam: “Farmer-to-Farmer Studies on Exposure and the Health Effects of Pesticides As a Baseline to
Measure the Impact of Community Integrated Pest Management”. Mr. Nguyen Duy Hong and Mr. Bui
Van Huyen and Mr. Nguyen Phung Hoan . Vietnam National IPM Programme, Hanoi: March, 2001.
Objectives:
This study was designed to measure the impact of Community Integrated Pest Management (CIPM) on
pesticide-related health problems. It was also to provide farmers with a deeper understanding of the
adverse human health effects of pesticide usage and as a product, stimulate interest in CIPM. Finally the
study was also to provide both the agriculture and health sectors better information on the pesticide use
and its adverse health effects in Vietnam.
Sites:
Two villages were selected in each of three North Vietnamese provinces where CIPM was to be initiated.
They included the provinces of Nam Dinh, Thai Binh, and Ha Tay.
Methods:
Eighty pesticide using vegetable farmers were randomly selected from each of the 6 villages for a total
sample size of 480, of which 53% were women. IPM farmers and farmer trainers were trained on
observation and interviewing techniques in each province by the National IPM team over a 6-day period.
They collected the data from April to May, 2000. They observed pesticide storage and disposal practices
in the homes and fields, observed a single spray operation and collected health data pre, post and 24
hours after the spray operation. They systematically followed 25 steps for the observations and
interviews.
Results:
41% of the entire 480 farmers were using a highly toxic product (Ib) while in one community it was 85%
of the sample. 100 farmers used methamidophos (Monitor and Filitox), which is formally banned by the
government. Most farmers were heavily poisoned by their pesticide solution through wet clothing, hands,
and feet. Protective equipment was rarely used because it is expensive and too cumbersome to use in the
hot climate of Vietnam. Improper pesticide storage was potentially contaminating food (44%), water
(36%), livestock (74%) and within reach of children (54%). Pesticide disposal was also a contaminant for
food, water and children in a third of the farms while for livestock, 60% were at risk. On average,
farmers experienced 6.1 mild, 1.8 moderate, and 0.04 serious signs or symptoms directly after spraying.
Over a quarter of the farmers had > 4 signs of pesticide poisoning. At least 17.5% of farmers had a
moderate sign of pesticide poisoning (ataxia-staggering). Another 2% vomited on site, and three farmers
possibly passed out and had a seizure. Those farmers who used more organophosphates (Op) and highly
toxic products (Ib) had higher rates of adverse effects. Farmers in Nam Dinh Province used more than
one OP per spray session - 1.4 / session versus .80 in Thai Binh and .45 in Ha Tay. Ninety percent (90%)
used class Ib (highly toxic) pesticide compared to 83% and 45% among Thai Binh and Ha Tay farmers,
respectively. The rates of total signs and symptoms per spray operation among the Nam Dinh farmers
were 10.3 versus 8.4 and 4.8 among the Thai Binh and Ha Tay groups.
Discussion:
The results appear to be significantly valid because they demonstrated the same risk factors -use of
highly neurotoxic products- for pesticide poisoning that were demonstrated in other medically supervised
controlled studies, which observed multiple spray operations. Furthermore, this study demonstrated that
20
ABSTRACT 6. Vietnam Baseline Survey
farmers could develop skills to effectively assess and document the health effects of pesticides within
their communities. The study was presented to the respondent communities to promote community IPM
and will be repeated to measure the impact of CIPM in May 2002.
21
ABSTRACT 7. Indonesia Farmer’s Study
Indonesia: “Health Study by Farmers In Pacet, East Java” Heru Setyoko and Nugroho Wienarto. FAO
Community IPM Indonesia. Jakarta. March 1999.
Objectives:
The purpose of the study was to identify the pesticides in use in highland vegetable farming and identify
its impacts on farmer’s health.
Site:
The site chosen for the health study was a vegetable growing area in the Pacet sub-district of Mojokerto
district in East Java. It lies 900 meters above sea level. The main crops are garlic, chili and onions to
which the IPM program suspected high amounts were being applied.
Methods:
After the study site was selected, meetings were held with the community of vegetable farmers to discuss
the aims of the study and the data collection methods. From five farmer groups, 10 farmers were selected
as interviewers. They then selected 6 farmers each to interview with a standardized questionnaire used in
a previous published study conducted in Brebes, East Java2. Over a two-week period a total of 60 farmers
were interviewed. The farmer interviewers then presented back to the respondents in their farmer group
meetings the summarized the data.
Results:
There were five major pesticide families in use by farmers in the area: pyrethroids, thiocarbamates,
carbamates, organochlorines and organophosphates. Of the 20 formulations used, 2 were WHO category
Ib (highly hazardous) and 13 were WHO category II (moderately hazardous). Eighty-eight (88%) of the
respondent’s bodies were soaked with pesticides by the time they finished applying their pesticide
solutions with backpack spray units. There were 12 reported signs of poisoning. Those that were
localized irritation from the chemicals were red eyes (25%) and white/scaling or red rash (37%). The
signs of runny nose (17%) and cough (17%) could have been either localized respiratory irritation
through inhalation or a systemic over-stimulation of the respiratory tract from cholinesterase depression.
The excessive sweating reported by 48% could also be attributed to the latter or due to heavy labor or hot
weather. Those more clearly defined moderate signs of pesticide poisoning were tremors (50%), eyelid
twitching (12%), staggering (27%), diarrhea (13%) and vomiting (8%). Most alarming were the reports
of severe poisoning. Three percent of the respondents said that they had lost consciousness and 2% had a
seizure. Sixteen different symptoms were reported, the majority of which were localized. These included
dry or sore throat (63% and 7%), eye and nose irritation (37% and 17%), and itchy skin (32%). Excessive
salivation and numbness were reported by 32% and 22% respectively, both of which could have been
localized or systemic effects. The vague or poorly defined symptoms that are possible systemic effects
were fatigue (77%) dizziness (48%) and headache (42%). Symptoms that more clearly reflected
moderate poisoning that the farmers reported were nausea (35%), chest pain (25%), blurred vision (18%),
shortness of breath (8%), and muscle or stomach cramps (12% and 19%).
Kishi M. et al. Relationship of pesticide spraying to signs and symptoms in Indonesian farmers. Scan J Work Environ Health
1995;21:124-33.
2
22
ABSTRACT 7. Indonesia Farmer’s Study
Discussion:
On completion of the survey the farmer groups discussed what pesticides they found in use and their
impacts on health, pests, natural enemies and the ecosystem. The IPM Farmer Associations will be using
farmer conducted health studies such as this for village campaigns as well as for dialogues with district,
provincial and national IPM farmer policy makers. This model will be used by the Indonesian FIELD
Foundation to carry out a farmer health impact study with women and young farmers in several districts
in the future.
23
ABSTRACT 8. Philippines IRRI Worker Survey
The Philippines: “Initial Results of Community Health Monitoring Activities at IRRI” Romeo F.
Quijano. PAN Philippines, IOHSAD, PAN Asia-Pacific. Philippines. March, 2002.
Objective:
This study was designed to describe the work and health conditions of the workers employed by the
International Rice Research Institute (IRRI).
Site:
The study was conducted in the communities of Bay and Los Banos in Laguna Province over a six month
period.
Methods:
Volunteers from local affiliates of national peasant and worker organizations gathered the data through
interviews. The IOHSAD (Institute of Occupational Health Safety and Development) conducted the
training for the volunteers, reviewed and analyzed the results. The study sample was 88 former IRRI
workers.
Results:
Most of the sample had worked for IRRI more than 20 years as core-regular workers (non-contractual or
non-probationary workers) in the IRRI experimental fields for 8 hours a day. Although not specifically
quantified, 78% had some sort of direct pesticide exposure either through pesticide application or by
virtue of working in areas that had been sprayed. 43% had no training or orientation on the use of
pesticides. Of those that had some training, only a third learned about the effects and health hazards of
pesticides, 39% were trained on the use of personal protective equipment (PPE) and another 26-27%
learned about safe disposal and storage. Pre-employment medical exams were performed on 82% of the
workers that included chest x-rays, blood counts, and urinalysis (82%), electro-cardiograms (53%),
neurologic exams or EMG studies (11 and 18%), pulmonary function tests (11%), blood cholinesterase
(19%), eye exams (40%) and liver examinations (15% LFT blood tests). Twenty different pesticides were
used. Of the 15 that a common name could be identified, 67% are class II pesticides that are moderately
hazardous to human health. Two products –monocrotophos and carbofuran- which are Ib (highly
hazardous), were used by 44% and 47%, respectively, of the study population. There were four
organophosphates, two organochlorines (endosulfan and endrin), two carbamates, and one pyrethroid.
PPE was not always provided. Mask or respirators were available to 52%, gloves – 42%, boots – 30%,
and coveralls or plastic aprons to 78%. Even if available, only 24% always used a mask/respirator or
gloves, 12% used protective clothing and 17% eye protection. Proper hygiene was followed by more of
the workers. 60% always wash their hands immediately after spraying, 59% bathe within 8 hours, but
only 44% wash their face within one to two hours after spraying. Only 38% change clothes one to two
hours after applying pesticides and 18% will smoke during a spray operation. 63% complained of some
adverse health effect subsequent to pesticide exposure in the field. Most of the complaints were mild,
local irritation, or more difficult to define such as skin irritation, dizziness, cough, ‘soggy eyes’
(excessive tearing), and numbness. Those potentially associated to cholinesterase inhibition included
severe headaches, ‘motion sickness’ (nausea or giddiness), tremors, vomiting and chest pain.
Discussion:
The study demonstrated a number of problems for these workers. Less than half had adequate training on
the hazards of pesticide use. Although most had some sort of pre-employment medical exams, there was
24
ABSTRACT 8. Philippines IRRI Worker Survey
no evidence of monitoring during their employment. Two highly hazardous products were being used by
almost half of the respondents. Other than protective clothing, other critical PPE was only available to
half or less than half of the workers. Even when available, PPE is consistently used by only a quarter of
the workers. Although the illness rates are not known, the workers did have moderate pesticide
poisoning complaints that could be associated to cholinesterase depression. Clearly hazardous pesticides
cannot be used with any safety in these conditions nor are there any measures being taken to responsibly
protect these worker’s health.
25
ABSTRACT 9. Sri Lanka 1 Month Surveillance
Sri Lanka: “Farmer Self –Surveillance of Pesticide Poisoning Episodes: A Report on a One Month
Pilot.” Mr. Subhash Rathnaweera and Ven. Pannananda. Community Education Centre and the Office of
Registrar of Pesticides. Kandy. February, 2002.
Objectives:
This study focused on educating farmers to self-report adverse health effects from pesticides in the main
agricultural zones of Sri Lanka. The specific objectives were to:
i) Determine the incidence of occupational pesticide poisoning.
ii) Determine the magnitude of poisoning from specific pesticides used by farmers.
iii) Educate farmers on the adverse health effects of indiscriminate pesticide use through self-reporting.
Sites:
This one-month pilot served as the first step in preparation for a yearlong surveillance study. It was
conducted during January 2002 in five different agricultural villages in the districts of Monaragala,
Trincomalee and Anuradhapura. The major crops grown in these areas are rice, vegetables, tobacco and
sugarcane.
Methods:
Initially, twenty-four NGO staff members were trained on the signs and symptoms of pesticide
poisoning, the conditions that mimic pesticide poisoning, pesticide product recognition and how to use
the self-reporting forms. After this five-day training, they randomly selected and trained 193 farmers
from three villages in Moneragala and one village each from Anuradhapura and Trincomalee districts. As
a group and individually during household visits, these farmers were given the same training as the NGO
staff. The farmers then practiced reporting for a month after each spray session the following: crops
sprayed, pesticides and number of tanks used, hours sprayed and any signs or symptoms (S&S)
experienced during or up to 24 hours after spraying. They recorded this information on a single page
pictorial body map form. Each week the forms were gathered and checked by the NGO staff. Each spray
session was categorized for adverse effect events: no effect, minor (ill-defined, vague or minor S&S),
moderate (at least one clearly defined neurotoxic S&S), or severe (loss of consciousness or seizure). All
the recorded information was summarised and presented back to the respective farmers for their
consideration and group discussions.
Results:
During the selected study period of one month, there were 524 spray operations among the 193 farmers,
averaging 2.7 spray operations/farmer/month (range 1-14). The most commonly used pesticides were
chlorpyrifos (21%), glyphosate (12 %) and MCPA (6%). Although mixing more than one product
together is not a recommended practice by the Department of Agriculture, 3.5% (18 applications) out of
524 spray applications were mixtures of three pesticides and 13% (67 applications) were mixtures of 2
pesticide products. These sessions were associated to more adverse effects. There were 4.1 and 6.7 total
signs and symptoms per spray operation of cocktail mixtures with 2 and 3 pesticides, respectively,
compared to 3.4 using only one product alone. Most farmers used class II, III & IV (WHO Hazard
classification) formulations. Class Ia & Ib formulations are banned in Sri Lanka. During 81.1% of the
spray sessions, operators reported some type of adverse effect. Out of 524 spray operations 19% were
asymptomatic, 45% were associated to mild effects and 35% had at least one clearly defined moderate
effect. There were 3 serious poisoning events. One farmer reported he passed out during two different
spray operations when using chlorpyrifos and another had a seizure while using banned methamidophos.
26
ABSTRACT 9. Sri Lanka 1 Month Surveillance
Discussion:
The NGOs reported that the participating farmers were highly interested in the project and now are
overwhelming them with demands for IPM or other alternatives to pesticides. Other symptoms that were
spontaneously reported - restlessness and nightmares that are associated to the central nervous system
effects of cholinesterase inhibitors- are indications that farmers experiencing and correctly reporting
pesticide specific effects. Because the majority of farmers apply a single pesticide, the study will be able
to assess product-specific adverse effects. The study will continue for another 11 months to better
determine over time the proportion of occupationally related pesticide poisonings that are not necessarily
seen by the health care sector.
27
ABSTRACT 10. Vietnam 12 Month Surveillance
Vietnam: “Farmer 12 Month Self-Surveillance of Pesticide Poisoning” Nguyen Phing
Hoan. Vietnam National IPM Program. Hanoi. November, 2001.
Objectives:
This pilot program was designed to:
(i) Determine the incidence of occupationally related pesticide poisoning that might not
have been reported to the health care system
(ii) Provide feedback to the self-reporting farmers on the extent of pesticide poisoning
found each month.
iii) Determine if feedback would change farmers’ spray frequency and choice of pesticide
products.
Site:
The pilot was conducted in Nam Doung village in Nam Dinh Province that cultivates
vegetables, uses large amounts of pesticides and has a strong Integrated Pest Management
Program (IPM) team to conduct the pilot.
Methods:
Ten IPM farmer graduates who had previously conducted other cross-sectional health
studies were intensively retrained over a 2 day period on the signs and symptoms (S&S) of
pesticide poisoning, conditions that mimic poisoning, pesticide product recognition and
use of the reporting form. They in turn selected 5 reporting and 5 non-reporting farmer
controls in 10 hamlets matched by crops and growing seasons. After training the 50reporting farmers with the similar above stated methods, a one-month trial followed. It
allowed evaluation of the process, further training and revisions of the form. From
November 2000 to October 2001, after each spray session the 50 farmers reported on:
crops sprayed, pesticides and the number of tanks used, hours sprayed and any signs of
symptoms experienced during or up to 24 hours after spraying. They recorded this
information on a single page pictorial body map form. Each week the forms were gathered
and checked by the IPM farmers. Each spray session was categorized for adverse effect
events: no effect, minor (only ill-defined, vague or minor S&S), moderate (at least one
clearly defined neurotoxic S&S), or severe (loss of consciousness or seizure). Data on
crops, spray frequency, tanks, hours and pesticide products were also gathered from the
controls at the same time. Monthly, the data was summarized and presented back to the
reporting farmers.
Results:
In a year, the 50 farmers sprayed a total of 1,798 times- on average 3
sessions/month/farmer. The majority (81%) sprayed 2 - 5 times a month- the maximum
was 14. Thirty-seven different products were used of which 35% were organophosphates,
5% carbamates, and 32% pyrethroids. Three to six products were mixed together in one
tank in 27% of the spray operations. A class II (moderately hazardous) product was used
in every spray session and Class Ib (highly hazardous) products in 20%. Eight percent of
the spray operations were asymptomatic, 61% were associated to ill defined, vague or
minor symptoms, and 32% had at least one moderate adverse effect. On average the
cohort had 87 minor and 54 moderate adverse effect events a month. In other words, once
28
ABSTRACT 10. Vietnam 12 Month Surveillance
a month a more dangerous (moderate) sign or symptom was occurring that would require
a farmer to stop spraying and or seek medical attention. While both the reporting farmers
and non-reporting controls reduced their spray frequency in the last 5 months of the study
(June to November) the reduction was greater in the reporting group (50%) compared to
the controls (29%). During the same months, the reporting farmers also significantly
reduced their use of organophosphates (Op’s) and Ib products compared to the controls.
Use of Op’s dropped by 66% among the reporters compared to 14% in the controls. The
reduction of Ib products was more dramatic. The reporters dropped their use by 97%
versus 37% among the controls. These reductions in the reporting group were likely a
product of monthly feedback and a discussion on pesticide poisoning risk factors during
their meeting in May 2001. This resulted in marked reductions in the percent of spray
operations associated to a moderate adverse effect (from 42% to 18%).
Discussion:
While the data is not validated by biomarkers, it reveals a fair amount of adverse effects
not seen by the health sector that correlated to the use of more neurotoxic products.
Furthermore, self-reporting coupled with monthly feedback and discussion positively
influenced farmer practice. The results were turned over to the Ministry of Health and the
entire cohort joined IPM farmer field schools at the end of the study.
29
ABSTRACT 11. Malaysia Women’s Study
Malaysia: “Poisoned and Silenced. A Study of Pesticide Poisoning in the Plantations.”
Tenaganita and Pesticide Action Network (PAN) Asia and the Pacific. March 2002.
Objective: This study was sponsored by PAN Asia Pacific and the National Poison Center
with the objective to document the adverse effects of pesticides, build awareness among
female plantation workers on the health hazards of pesticide use, help them promote the
protection of their own health with employers and unions. Finally the results of the study
would be used to develop educational and advocacy strategies.
Site: The study was conducted in the states of Kedah, Penang, and Perak within peninsular
Malaysia among rubber and oil palm plantation workers.
Methods: 72 woman sprayers were selected for documentation of the health problems
associated with pesticide spraying. A subset of this sample (39) was tested for AchE
depression using screening serum pseudo cholinesterase. Those who had abnormal results
were retested with serum cholinesterase and medical examinations. Another 67 women
sprayers self-reported health problems associated to spraying over a 3-month period.
Results: The women were Malay (35%) and Indian (65%), almost all were married (93%)
and on average were 36-year-old mothers with 4 children. They had been employed an
average 7.2 years earning 14.6 ringgits/day ($3.84). All were permanent employees,
working on average 7 hours per day. Most were spraying throughout the year (89%) for an
average of 262 days per year. Of these, only 37.5% were given an average 2.8-month
break from their spraying duties. Six each were pregnant or breastfeeding while
employed. Sixty-five percent were sprayers applying what they thought were primarily
herbicides, the most common of which were paraquat, Metsufon, flyphosate, 2,4,-D and
flufosinate ammonium. Only 30% thought they were applying an insecticide. It is common
practice not to disclose the names of the pesticides to the sprayers. The most common
pesticide application method was by backpack hand pump (79%) for which 37.5% of the
woman had received no training. Thirty three percent of the woman did not have access to
any personal protection equipment (PPE). Missing PPE included coveralls (87.5%), gloves
(54%), eye and face protection (83%), apron and coat (97%), boots (74%), respirators
(39%). The most commonly reported exposures to pesticides were inhalation of the spray
mist, reported by 99% of the women and dermal contact, 97%. Only 10% mix the
pesticide solution themselves of which 9 reported using a combined multiple pesticide
concentrate cocktail. The most commonly reported health effect ‘ever experienced’ was
fatigue (86%), which cannot be differentiated between hard labor and pesticide
intoxication. Tremors (19%) could be from prolonged muscle use (repetitive hand pump
action) or a neurotoxic effect commonly associated to organophosphates or carbamates.
Those other more definitive neurotoxic effects were nausea and vomiting (46% and 18%
respectively), ataxia or giddiness (57%), and blurred vision (19%). Discoloration of the
nails (17%) and nose- bleeds (19%) can be associated to paraquat. Difficulty breathing
(47%) and tightness in the chest (40%) can be local irritation to the respiratory tract from
any chemical product or a neurotoxic effect. Other reported local effects were skin and eye
irritation (47% and 44% respectively). All of the respondents usually sought medial care
for these health complaints of which 74% received some sort of treatment. The actual
30
ABSTRACT 11. Malaysia Women’s Study
incidence of adverse effects experienced during the three-month self-reporting period
included non-specific complaints of headache, exhaustion (13%) and dizziness (9%). The
localized effects were eye irritation and skin rashes, 8% and 7% respectively. Those more
serious effects possibly indicating cholinesterase depression during the reporting period
included blurred vision (5%), chest pain (4%), nausea (3%), shortness of breath (2%),
tremor (2%), and vomiting (1%). Twenty sever sprayers (69%) had a single depressed
pseudo-cholinesterase enzyme level. Of these, six women were tested again after a onemonth break in spraying. All had a greater than 15% rise, which is an indication that the
first measurement reflected pesticide poisoning with an organophosphate or carbamate.
Discussion: Clearly these women plantation workers are heavy exposed to pesticides on a
daily basis for long periods of time. Thirteen to 9% of the women experienced a potential
systemic effect (headache and dizziness) while from 5 to 1% had clear signs of
neurotoxicity. Although difficult to document, the potential unknown long-term effects to
themselves and their offspring could be significant. These women are definitely at risk.
Improper protection of their health, inadequate monitoring and enforcement of labor laws
calls for immediate action. The study had a number of recommendations that included
better medical monitoring of workers, worker education and awareness raising of their
rights, banning or restricting those most hazardous pesticides, promotion of alternatives to
chemical pest controls, and the integration of the gender perspective in the analysis of the
occupational hazards of pesticides.
31