pesticide use behaviour and potential health risks...
TRANSCRIPT
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PESTICIDE USE BEHAVIOUR AND POTENTIAL HEALTH
RISKS AMONG PESTICIDE APPLICATORS IN
KUTTANAD AREA, KERALA, INDIA
JASMINE JOMICHEN
Dissertation submitted in partial fulfillment of the
requirement for the award of
Master of Public Health
ACHUTHA MENON CENTRE FOR HEALTH SCIENCE STUDIES
SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES & TECHNOLOGY
Trivandrum, Kerala
October 2014
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ACKNOWLEDGEMENT
First of all, I would like to thank God almighty who blessed and enabled
me to complete my research work.
I would like to express my sincere gratitude and indebtedness to my guide,
Dr. Manju R Nair for her invaluable suggestions and supervision throughout my
dissertation work. I would also like to express my deepest appreciation to Dr. Sankara
Sarma who cleared my doubts in statistics and gave advice for my work. I want to thank
all the other faculty members who guided me during the two years of study in AMCHSS.
I take this opportunity to thank Dr TK Joshi, Director, COEH, New Delhi
for his suggestions given for the thesis work. I would like to acknowledge Dr. P Indira
Devi, Director, Centre of Excellence in Environmental Economics, Thrissur for help in
obtaining information related to pesticides and also for her expert guidance. I would also
like to thank Dr. Mohammed Asheel who helped me for literature search related to
pesticide and its health effects.
I am immensely grateful to my father, whose inspiring attitude helped me throughout the
data collection of my thesis work. Without his guidance and ceaseless encouragement, this
dissertation would not have been possible. I am also thankful to my family members and
friends – Joanna Sara Valson, Dona George, Minu Abraham and Peeyush for their love
and encouragement in the course of study. Lastly, I would like to present my heartiest
gratitude to all the pesticide applicators who agreed to participate in the study.
Jasmine Jomichen
October 2014
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DECLARATION
I hereby declare that this dissertation titled “Pesticide use behaviour and
potential health risks among pesticide applicators in Kuttanad area,
Kerala, India” is the bonafide record of my original field research. It has not
been submitted to any other university or institution for the award of any
degree or diploma. Information derived from the published or unpublished
work of others has been duly acknowledged in the text.
JASMINE JOMICHEN
Achutha Menon Centre for Health Science Studies
Sree Chitra Tirunal Institute for Medical Sciences & Technology
Trivandrum, Kerala
October 2014
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CERTIFICATE
Certified that the dissertation entitled “Pesticide use behaviour and
potential health risks among pesticide applicators in Kuttanad area,
Kerala, India” is a record of the research work undertaken by Ms. Jasmine
Jomichen in partial fulfillment of the requirements for the award of the
degree of “Master of Public Health” under my guidance and supervision.
DR. MANJU R NAIR
Scientist C
Achutha Menon Centre for Health Science Studies
Sree Chitra Tirunal Institute for Medical Sciences & Technology
Trivandrum, Kerala
October 2014
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Table of contents
Content Page no:
Acknowledgement……………………………………………………..
ii
List of tables and figures……………………………………………… v
Glossary of abbreviation……………………………………………… vii
Abstract................................................................................................ viii
CHAPTER -1 INTRODUCTION
1.1 Background................................................................................. 2
1.2 Pesticide poisoning burden: global context.............................. 3
1.3 Pesticide use in developing countries.......................................... 3
1.4 Indian context................................................................................ 4
1.5 Kerala context............................................................................... 5
CHAPTER -2 LITERATURE REVIEW
2.1 Acute pesticide poisoning............................................................. 6
2.2 Chronic effects of pesticides......................................................... 7
2.3 Classification of pesticides........................................................... 7
2.4 Integrated pest management strategy........................................ 8
2.5 Occupational pesticide exposure................................................. 8
2.6 Measurement of pesticide exposure............................................ 9
2.7 Factors that affect the use of pesticide
2.7.1 Knowledge about pesticide.......................................................... 9
2.7.2 Perception about pesticide risk.................................................... 10
2.7.3 Safe work behaviour
2.7.3.1 Personal protective behaviour.................................................. 10
2.7.3.2 Storage practice......................................................................... 10
2.7.3.3 Disposal of empty containers.................................................... 11
2.7.3.4 Pesticide mixing behaviour....................................................... 11
2.7.3.5 Personal hygiene and sanitation practices................................ 11
2.7.3.6 Nature of work.......................................................................... 12
2.8 Objectives of the study................................................................... 13
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2.9 Rationale of the study.....................................................................
13
CHAPTER -3 METHODOLOGY
3.1 Study design..................................................................................... 14
3.2 Study setting.................................................................................... 14
3.3 Study population............................................................................. 14
3.4 Inclusion criteria............................................................................. 14
3.5 Exclusion criteria............................................................................ 15
3.6 Sample size...................................................................................... 15
3.7 Sample selection procedure........................................................... 15
3.8 Data collection procedure.............................................................. 15
3.9 Data collection process................................................................... 16
3.10 Variables under the study
3.10.1 Definition of the variable............................................................. 17
3.10.2 Operational definition.................................................................. 17
3.10.3 Outcome variable......................................................................... 18
3.10.4 Predictor variable definitions....................................................... 18
3.11 Plan for dissemination.................................................................. 20
3.12 Data storage and data cleaning................................................... 20
3.13 Data analysis and statistical methods......................................... 21
3.14 Expected outcomes........................................................................ 21
3.15 Ethical considerations.................................................................... 21
CHAPTER -4 RESULTS
4.1 Profile of the study population.......................................................... 22
4.2 Occupational characteristics............................................................. 23
4.3 Pesticides used.................................................................................... 25
4.4 Mixing of pesticides............................................................................ 26
4.5 Source of knowledge about spraying................................................ 27
4.6 Knowledge about colour code and hazard symbol.......................... 28
4.7 Perception about health risks............................................................ 29
4.8 Pesticide use practice......................................................................... 29
4.9 Personal protective behaviour.......................................................... 31
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4.10 Personal hygiene and sanitation practices..................................... 34
4.11 Co-morbidities.................................................................................. 34
4.12Acute pesticide poisoning.................................................................. 35
4.13 Bivariate results................................................................................
4.13.1 Bivariate analysis of socio demographic characteristics with APP. 37
4.13.2 Bivariate analysis of pesticides used associated with APP............. 38
4.13.3 Bivariate analysis of pesticide mixing behaviour with APP........... 39
4.13.4 Bivariate analysis of personal protective equipments with APP..... 39
4.13.5 Bivariate analysis of personal hygiene and sanitation practices
with APP.....................................................................................................
40
CHAPTER -5 DISCUSSION AND CONCLUSION
5.1 Socio demographic characteristics.................................................. 46
5.2 Work characteristics.......................................................................... 46
5.3 Pesticides use behaviour..................................................................... 47
5.4 Storage of pesticide containers.......................................................... 48
5.5 Spraying equipment........................................................................... 48
5.6 Mixing of pesticide ingredients.......................................................... 49
5.7 Disposal of empty containers............................................................. 49
5.8 Timing of spraying............................................................................. 50
5.9 Knowledge about spraying
5.9.1 Knowledge about colour code and hazard symbol........................... 50
5.9.2 Reading labels on pesticide package................................................. 51
5.9.3 Source of information........................................................................ 52
5.9.4 Training............................................................................................. 53
5.10 Perception about health risks.......................................................... 53
5.11 Personal protective behaviour......................................................... 54
5.12 Chronic morbidities.......................................................................... 54
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5.13 Personal hygiene and sanitation practices..................................... 55
5.14 Acute pesticide poisoning................................................................. 56
5.15 Strengths of the study...................................................................... 56
5.16 Limitations of the study................................................................... 57
5.17 Conclusion......................................................................................... 57
5.18 Policy implications............................................................................ 58
REFERENCES........................................................................................ 59
ANNEXURES
Annexure I
Annexure II
Annexure III
Annexure IV
Annexure V
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List of tables
Table no: Heading Page no:
3.9
Summary of the final sample recruitment process.............................
17
4.1 Profile of the study population.......................................................... 23
4.2 Occupational characteristics of the study population....................... 24
4.3 Pesticides used................................................................................. 25
4.4 Mixing of pesticide contents............................................................. 27
4.5 Source of knowledge about spraying and training........................... 28
4.6 Knowledge about colour code and hazard symbol........................... 28
4.7 Perception about health risks............................................................ 29
4.8 Pesticide use practice........................................................................ 30
4.9.1 Personal protective behaviour.......................................................... 32
4.9.2 Reason for non-compliance towards protective measures............... 33
4.10 Personal hygiene and sanitation practices........................................ 34
4.11 Co – morbidities............................................................................... 35
4.12.1 Acute pesticide poisoning................................................................. 35
4.12.2 Signs and symptoms reported........................................................... 36
4.13.1 Bivariate analysis of socio demographic characteristics with APP... 37
4.13.2 Bivariate analysis of pesticides used with APP............................... 38
4.13.3 Bivariate analysis of pesticide mixing behaviour with APP............. 39
4.13.4 Bivariate analysis of personal protective equipments with APP....... 40
4.13.5 Bivariate analysis of personal hygiene and sanitation practices with
APP....................................................................................................
40
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List of figures
Figure no: Heading Page no:
3.2
Map of Kuttanad......................................................................
14
4.3 Chemical nature of pesticides used by the applicators............ 26
4.14.1 Spraying equipment................................................................ 41
4.14.2 Pesticide mixing behaviour.................................................... 41
4.14.3 Personal protective behaviour............................................... 43
4.14.4 Disposal of empty containers................................................ 43
4.14.5 Storage of pesticides............................................................. 44
4.14.6 Personal hygiene and sanitation practices............................ 44
4.14.7 Source of information........................................................... 45
5.9.1 WHO Colour codes and hazard symbol................................ 51
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Glossary of abbreviations
DDT Dichlorodiphenyltrichloroethane
FAO Food and Agriculture Organisation
GDP Gross Domestic Product
BHC Benzene hexa chloride
WHO World Health Organization
LD Lethal dose
EPA Environmental protection agency
IPM Integrated pest management
PPE Personal protective equipment
APP Acute pesticide poisoning
UNEP United Nations Environment Program
2,4-D 2,4 – Dichloro phenoxy acetic acid
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ABSTRACT
Introduction: Occupational acute pesticide poisoning among agricultural workers is a
major issue in the developing countries including India with poorly regulated pesticide
use. There is considerable paucity of data on these poisoning due to lack of routine
surveillance and poor documentation. This study explored the pesticide use patterns and
the magnitude of related acute poisoning among pesticide applicators in the rice fields of
Kuttanad, Kerala, India.
Methods: A cross sectional survey among 270 male pesticide applicators was done in 96
clusters of paddy fields across six villages in Kuttanad using Murphy’s farmer self-
surveillance system for pesticide poisoning. Descriptive statistics was used and bivariate
analysis using Chi-square test done to assess association between APP and other factors.
Results: The prevalence of self reported acute pesticide poisoning (APP) among the
pesticide applicators was 62 percent. The most common symptoms reported were skin
irritation (87.5%) followed by twitching of eyes and itching of eyelids (25.6%). Twenty
eight active ingredients were reported to be in use. Organophosphates and Pyramidinyl
thiobenzoate being the most commonly used. Three banned/restricted chemicals were in
use and 78.1 percent applicators handled WHO Class I agents. Colour codes indicating
pesticide toxicity was known to only 20 percent of respondents. None of the applicators
used all the prescribed personal protective equipment. Personal protective behaviour was
significantly associated with less APP. Mixing of pesticides with bare hands and hours
spent on spraying were significant risk factors for APP. Unsafe storage and disposal
practices threatening the ecosystem were also found among the applicators.
Conclusion: The results of the study indicate that considerable morbidity due to pesticide
poisoning exists among applicators that warrant regular surveillance and monitoring.
Periodic training programmes and strict enforcement of regulations are also needed to
promote safe use, storage and disposal of pesticides.
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CHAPTER -1
INTRODUCTION
Pesticide use has become ubiquitous in agriculture industry. An emergence in
pesticide use began after the invention of Dichlorodiphenyltrichloroethane (DDT) in
1939. Since then, pesticides have substantially contributed to protecting agricultural
production and are also used in great quantities in domestic and public health
purposes such as in vector control. It was Rachel Carson’s ‘Silent spring’ published in
1962 that stimulated widespread public concern about the dangers of inappropriate
pesticide use to ecosystem as well as to human health. It triggered a series of
regulations in the developed countries to control the excessive and unrestricted use of
pesticides.
The ideal pesticide is both safe in terms of human health and ecosystem as well as
effective at controlling the target species. Most of the pesticides tend to exhibit
adverse health effects if ingested, inhaled or if they come in direct contact with skin.
Researchers have found a link between pesticide exposures and chronic morbidities.
Developing countries witness a major proportion of deaths occurring due to pesticide
exposure. Despite the low pesticide consumption in India in comparison to data from
other countries, the burden of morbidity and mortality due to pesticide poisoning is
alarmingly high. Agricultural workers who handle pesticides are the ones who are
most directly exposed and likely to be affected with the acute effects caused by them.
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1.1 Background
The FAO in 1986 defined pesticides as “any substance or mixture of substances intended
for preventing, destroying or controlling any pest, including vectors of human or animal
disease, unwanted species of plants or animals causing harm during or otherwise
interfering with the production, processing, storage or marketing of food, agricultural
commodities, wood and wood products or animal food stuffs or which may be
administered to animals for the control of insects, arachnids or other pests in or on their
bodies”.1
Paris green was one of the first compounds to be used on a large scale in agricultural
settings. Later in the 19th
century, lead arsenate started to be widely used.2 Dramatic
increase in pesticide use was observed after the invention of DDT in 1939 by Paul
Muller. Pesticides were used for military purpose during Second World War to clear the
vegetation cover in jungle warfare as well as to control insect problems that hindered the
war effort. Post world war, DDT and similar chlorinated pesticides entered the
agricultural market place. This introduction changed the global pest control and food
production.2
Pesticides are important public health tools as they are used in preservation of food
supplies and prevention of vector-borne diseases. They increase agricultural productivity
by reducing loss from harvest due to weeds, diseases and insect pests. Insecticides
protect wooden structures and buildings from wood boring insects. Herbicides and
insecticides are also used to maintain the turf on sports pitches.3 On the contrary,
pesticides are proven to be toxic resulting in adverse effects.4 Residues of pesticides may
remain in treated products and enter human body through food chain. Certain pesticides
tend to bio-accumulate and becomes more concentrated in an organisms body.5
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Pesticides are also toxic to many organisms such as birds, fish, beneficial insects,
earthworms, natural insect habitats and non-target plants.6 Research has shown that only
0.1 percent of pesticide spraying targets the pest while the remaining 99.9 percent seeps
into and damages the environment.7
1.2 Pesticide poisoning burden: Global context
Agriculture is an extremely hazardous industry which has a huge magnitude of
occupational injuries and chronic illness associated with it.8 Worldwide 1.3 billion
workers are employed in agriculture, which constitutes half of the total world labour force.
The incidence rate of pesticide-related illness in the workplace was approximately 1.17
per 100,000 full time equivalent workers.9 About one million serious unintentional
pesticide poisoning occur each year, out of which 300,000 die.10,11
WHO and UNEP
estimates that pesticide poisoning occur at the rates of 2-3 per minute.12
Globally, 5 billion
pounds of pesticides are consumed annually. Out of the total pesticides used, 45 percent
are herbicides and 30 percent are insecticides.13
1.3 Pesticide use in developing countries
Pesticide spraying is one among the most hazardous activity among agricultural workers
in developing countries.14
Although the consumption is just 25 percent out of the pesticides
produced worldwide, 99 percent of deaths occur here.15
Since the inception of green
revolution, around 800,000 deaths have occurred due to pesticides in developing
countries. WHO task group estimates that 25 million agricultural workers in the
developing world suffer from pesticide poisoning each year.11
Three million farmers
experience severe poisoning each year, out of which 18000 die.12
In developing countries,
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annual incidence rate of pesticide poisoning in agricultural workers is 18.2 per 100 000
full-time workers.16
An FAO survey showed that 25 percent of developing countries lack
any kind of legislation to control the distribution and use of pesticides while 80 percent
lack the resources to implement and enforce the legislation that are prevailing.17
1.4 Indian context
Agriculture is vital to the Indian economy and contributes 25 percent to GDP. Agriculture
sector constitutes 54.6 percent of the total workforce in India.18
Currently, India is the
leading producer of basic pesticides in Asia and ranks twelfth in world for the use of
pesticides.19
In India, pesticide use was started in 1948 when DDT and BHC were
imported for malaria and locust control. Ever since the green revolution started in India in
1966, application of these chemicals increased by more than 100 times.7 There are more
than 234 registered pesticides in India. Despite having one of the lowest pesticide
consumption in the world with 0.58 kg/ha, magnitude of pesticide pollution is huge. It is
due to unscientific use and handling practices, lack of training in pesticide use, ignorance
about the health and environmental implications of pesticides, inefficient monitoring
system and climatic factors.20
Among the various pesticide formulations used, dust
formulations constitute 85 percent followed by water soluble dispersible powder (12%).
Insecticides account for 61 percent of total consumption, followed by fungicides and
herbicides.
Pesticide uptake is higher in a tropical country like India where temperature and humidity
is high.3 Studies in the country, though few have indicated significant morbidity due to
occupational exposure to pesticides.21,22
Prolonged exposure to pesticides have been
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linked to high incidence of cancer cases in Punjab.23
Farm workers do not have trade
unions nor access to occupational health services.21
1.5 Kerala context
Pesticide use pattern is different in Kerala with respect to other states of India due to its
cropping pattern.22
The first incident of pesticide poisoning in India occurred in Kerala in
the year 1958, where more than 100 people died after consuming wheat flour
accidentally contaminated with parathion.24
Out of the 900 to 1000 suicides which occur
per year in Kerala, 60 percent are due to consumption of pesticides such as Malathion,
Furadan and other rodenticides.22
A survey undertaken by Trivandrum Medical College
in 1993 found an increased occurrence of cancer of lip, stomach, skin and brain,
lymphoma, leukaemia and multiple myeloma which were linked to pesticide use.25
Nearly 73 percent of pesticides used in Kerala are fungicides followed by insecticides
(20%).22
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CHAPTER -2
REVIEW OF LITERATURE
This chapter includes the published literature on knowledge and perception about safe
pesticide use and its related health effects among pesticide applicators. The term pesticide
exposure refers to contact between a living organism and a pesticide, which may or may
not lead to poisoning. It could be intentional, accidental or occupational in origin.
“Pesticide applicators are those individuals who are involved in, and potentially can
experience exposure during the pesticide application process in agricultural and non-
agricultural settings.”26
Acute toxicity means an adverse effect occurring within a short
time of administration or absorption of a single or repeated dose given within or less than
24 hours.1
2.1 Acute pesticide poisoning (APP)
Actual incidence of pesticide poisoning is underestimated as most of the cases do not seek
hospital care.27,28
Health officers find it difficult to diagnose the poisoning cases or
identify the poison as farm workers identify chemicals with its trade name.29
Nearly 60
percent farm workers had typical intoxication symptoms in Brazil and Ethiopia, while in
Gaza strip in 2002, it was 83 percent.30,31,32
Studies report acute effects of pesticide
exposure such as insomnia, twitching eyelids, red eyes, blurred vision, runny nose,
burning nose, excessive salivation, excessive tearing, burning eyes, chest pain, sore throat,
cough, excessive sweating, fatigue, skin discomfort, dizziness, stomach cramps,
numbness, tremor, headache, nausea, vomiting, muscle weakness, muscle cramps, seizure,
diarrhoea, staggering gait and shortness of breath.33,34
More severe poisoning can result in
respiratory depression, loss of consciousness and death.
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2.2 Chronic effects of pesticides
A review of epidemiological evidence points out that pesticide exposure is linked with
cancers such as leukaemia, non-Hodgkin’s lymphoma, multiple myeloma, soft tissue
sarcoma, breast cancer, prostate cancer, ovarian cancer, pancreatic cancer, testicular
cancer and Hodgkin’s disease.35,36
There is linking evidence of pesticide exposure with
neurodegenerative diseases such as Parkinson’s disease, deficits in neurobehavioral
performance and abnormalities in nerve function.37
They also result in developmental,
endocrine, reproductive effects, respiratory problems, depression and birth defects. 38
Chronic pesticide poisoning is higher among agricultural workers and their family who
live in close proximity to fields where agrochemicals are applied.39
2.3 Classification of pesticides
WHO has classified pesticides by common names in terms of their potential human
health effects into 5 groups and have been colour coded such as – Extremely hazardous
(Ia)= red colour, Highly hazardous (Ib)= yellow colour, Moderately hazardous (II)=blue
colour, Slightly hazardous (III)=green colour and Unlikely to present acute hazard (U).
These are usually based on acute oral LD50 levels. LD or lethal dose is the number of mg
of chemical per kg of body weight required to kill 50 percent of laboratory test animals.
Most of the pesticides in WHO class I are banned or subjected to strict regulations in
industrial countries.12
A teaspoonful (5 ml) of one of these pesticides would be enough to
kill an adult.15
Most of the farmers used chemicals belonging to WHO classes I and II in
the year 2007 in Kuttanad.34,40
Pesticides are commonly classified according to their
intended target organism such as insecticides, herbicides, fungicides, nematicides,
rodenticides and miticides.
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2.4 Integrated pest management (IPM) strategy
“IPM is a comprehensive approach to pest control that uses combined means to reduce
the status of pests to tolerant levels while maintaining a quality environment”.41
Following
training given by IPM, it was observed that farmers reduced the use of pesticides which
led to 50 percent reduction in the incidence of acute pesticide poisoning.42
An all India
survey reported that 34 percent farmers were unaware of IPM technology and less than
five percent adhere to its adoption.43
Similarly, Koirala et al in his study pointed out that
although 68 percent farmers have heard about IPM technology, none of them adopt it in
their fields.40
2.5 Occupational pesticide exposure
Pesticide exposure is said to be occupational in origin if the exposure occurred while at
work.9 Occupational exposure of pesticide occurs during occasions such as mixing or
applying pesticides, planting, harvesting, irrigating, spraying equipment and through
pesticide drift to the untreated areas by means of wind.44
Factors which affect
occupational exposure include intensity, frequency, duration, method of application,
adoption of personal protective equipment, personal hygiene, temperature, humidity,
weather conditions and the physiochemical as well as toxicological profiles of
pesticides.45,46
Incidence rate of pesticide related illness in the workplace was found to be
1.17 per 100,000 full time equivalent workers.9 Exposure to pesticides occurs via
inhalation, oral ingestion or dermal absorption.47
Skin contact was reported as the most
common route of exposure.48
2.6 Measurement of pesticide exposure
Several methods have been employed to estimate agricultural pesticide exposure; the most
common being self- reported exposure based on questionnaires, job exposure matrices,
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exposure logarithms, personal measurements, scenario based assessment, passive
dosimetry and biological monitoring.36,85
Personal measurements measure pesticide concentration at the immediate contact
interface between subjects and pesticides.45
Scenario based assessment refers to
measurement of pesticide exposure using questionnaire or job titles.49
Biomonitoring
approach involves biomarkers or biomonitoring of pesticides or their metabolites.53
Bio-
monitoring approach of pesticide is expensive, time consuming, complex and involves
invasive techniques which are less favourable to the participants.54,55,56
Though objective
measurements to assess pesticide exposure are ideal, self- reports assessed by
questionnaires are frequently used to study occupational exposure to
pesticides.31,39,42,50,51,52
Work histories which are self- reported are the most commonly
used especially in the developing countries due to issues related to cost and the need for
complex technologies. Studies that have examined the validity of such measurements have
found that the method may be “adequate for epidemiologic analysis of broad categories of
pesticides but is a limitation for detecting more specific associations”.86
Questionnaires were mostly adapted from WHO Field Surveys of Exposure to Pesticides
Standard Protocol,39,50,51
United States Environmental Protection Agency
questionnaire,31,52
Vietnam Medical Questionnaire, Farmer’s self surveillance system of
acute pesticide poisoning42
etc.
2.7Factors that affect the use of pesticide
2.7.1 Knowledge about pesticide
Knowledge about the use of pesticide will determine farm worker’s action on spraying
the chemicals.48
Generally, they get information about the pesticides from pesticide
dealers, government agricultural offices, media advertisements, fellow applicators or
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sometimes from their own experience.34,56,57
Study from Nepal points out that majority
of the farmers were not aware about the toxicity labels on pesticide containers.56
Many
farmers are illiterate and they fail to understand safety instructions written in foreign
languages on pesticide packages.39
A public education program on safe handling of
pesticides was conducted among two villages in South India and it successfully
improved the level of knowledge, awareness and adoption of safety measures among
agricultural workers.58
Only 4 percent had undergone formal training in some areas.32,59
2.7.2 Perception about pesticide risk
In Cambodia, about 91 percent farmers believe that pesticides produce a deteriorating
effect on health.34
Majority of the farmers believe pesticides harmful to those who ate the
treated crop48,57
while some have the opinion that the chemical that they use on their
farm have little effect on human health.40
Sixty seven percent farmers believe that their
body has developed resistance to pesticides.31
2.7.3 Safe work behaviour
2.7.3.1 Personal protective behaviour
Wearing personal protective equipment (PPE) is assumed to be the most protective
behaviour for farmers as it reduces direct contact with skin and inhalation of pesticides.
Prescribed PPE includes rubber gloves, face mask with replaceable filter, rubber boots and
goggles. Clothing such as hat, full sleeve shirt and full pants are to be worn while
spraying. Some of the reasons cited by farmers for not using PPE includes the required
PPE not being provided, not being instructed regarding the use of PPE, high cost, time
consumed to wear them and not available when needed.34,48,60
About 98 percent workers in
West Bengal and 70 percent workers in Puducherry were found to be not using PPE
routinely.50,51
Pesticide handlers consider PPE to be impractical in humid tropical climate
of India.58
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2.7.3.2 Storage practice
A study carried out in Cambodia found that pesticides are commonly kept inside the
house in areas such as kitchen, living room or bedroom. Incidents of suicide are high in
areas where farmers store pesticides inside their homes.61
Negligible number of farmers
are found to use padlocks for the safe storage of pesticides.34,61
A confidential room was
meant for pesticide storage in Brazil and West Bengal.57,61
Nearly half of the farmers
stored them as hanging from the roof or walls while some stored pesticides at the top of
the house or along with the foodstuffs as revealed by a study in 2012 in Ethiopia.32
2.7.3.3 Disposal of empty containers
Karunamoorthi in his study in 2012 found out that about three-quarters of farmers used
empty pesticide containers for many other household purposes such as for food and water
storage.32
In a study conducted in Gaza strip in 2002, 64 percent revealed that they
disposed containers on garbage site or along the street.31
Disposal of containers by the
field or into the irrigation canals and streams was also revealed in a study.62
2.7.3.4 Pesticide mixing behaviour
The chemicals come in various forms such as gas, liquid and granular.63
Liquid
formulation are more likely to splash onto skin while spraying. Solid formulation lead to
exposure to the eyes and also acts as a respiratory hazard while mixing.64
Active
ingredients are mixed with solvents such as water, oil or other carriers so as to make the
application safer and easier.65
Poisoning is higher among farmers mixing a cocktail of two
or more pesticides.31
Eighty one percent of farmers in Ethiopia used knapsack sprayer
while eighteen percent used small cans with several hole to apply pesticide.32
Leakage
from joints in the spraying equipment or its blocked nozzles might lead to pesticide
exposure onto the skin.48
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2.7.3.5 Personal hygiene and sanitation practices
After spraying of pesticides, personal hygiene such as showering, hand wash and
changing clothes are essential to remove the pesticide contamination from body.40,63,66
Majority washed the clothes they had worn while spraying after several uses.48,50,51
These
clothes were separated from other clothes by pre-rinsing with hot water during which
women will be exposed to pesticides.48
Another study revealed the habit of farmers in
tasting pesticides to quantify dilution. More than half of farmers reported that they do not
eat, drink or smoke during spraying.7,50
More than half of the agricultural workers in
Nepal used pesticide contaminated utensils for kitchen gardening purpose and in
livestock sheds.56
2.7.3.6 Nature of work
For each extra hour of work involving pesticide spraying, the risk of having experienced a
moderate case of pesticide poisoning increased by 14 percent.34
Many of the pesticide
applicators have half-day shift which prevents them from exposure for a longer duration.39
Koirala et al in a study conducted in Nepal in 2010 elucidates that half of the farmers were
engaged in pesticide spraying since more than 10 years and more than half of them spent
more than 4 hours daily in pesticide spraying work.40
Exposure of farmer who applies
pesticide once in a year is lower than pesticide applicator who applies pesticide for many
consecutive days in a season.64
Data from Brazil shows that farmers chose the best time of
day for spraying such as early morning and at end of day. Farmers avoided spraying
during windy and sunny weather.57
If wind is against the spraying direction, it might spray
off the target. Sunny weather leads to rapid evaporation of the chemical formulations.39
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2.8 Objectives of the study
1. To assess the pesticide use behaviour among the pesticide applicators in Kuttanad area,
Kerala
2. To assess potential acute health effects related to their pesticide exposure
3. To assess the awareness regarding pesticide use among them
2.9 Rationale of the study
Widespread use of chemicals in agriculture has raised concerns about pesticide residues in
food and wider environmental degradation in the state. High use of pesticides has been
documented in the case of paddy cultivation in Kuttanad, the ‘rice bowl of Kerala’. Due to
the poor drainage conditions, crops other than paddy cannot be grown in Kuttanad and is
cultivated below the sea level. A survey undertaken by Trivandrum Medical College in
1993 reported an increased occurrence of cancer of lip, stomach, skin and brain,
lymphoma, leukaemia and multiple myeloma in Kuttanad which were linked to pesticide
use. However, most studies on the topic have been conducted by Agricultural Universities
and have therefore primarily focused on issues like economics of agriculture and the
ecological cost. There is a paucity of studies that have examined the issue from the stand
point of health effects associated with occupational pesticide exposure. Pesticide
applicators by nature of their work are a group that is highly vulnerable to the exposure of
pesticides. An understanding of the pesticide use practices and potential health effects
among them is therefore relevant to the health of those workers and to reduce the
occurrence of pesticide poisoning among farm workers. The results of the study could be
useful to develop and implement strategies related to safe use of pesticides and to address
the wider issues of pesticide management and persistent residues in food.
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CHAPTER -3
METHODOLOGY
This chapter briefly describes the methodology used to undertake the study.
3.1 Study design
The study was a cross sectional survey.
3.2 Study setting
The study area is Kuttanad which contributes to 20 percent of rice production in Kerala.67
Kuttanad consist of 10 taluks which is spread across three districts – Alappuzha, Kottayam
and Pathanamthitta.68
Figure 3.2 Map of Kuttanad67
(Written permission obtained from the author Narayanan SP)
3.3 Study population
Study population consist of pesticide applicators working in the paddy fields of Kuttanad
and who had sprayed pesticides for at least one season in the last one year.
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15
3.4 Inclusion criteria
Pesticide applicators who had sprayed pesticides for at least one season in the last one year
and who are aged 18 years or older.
3.5Exclusion criteria
Pesticide applicators who have not applied pesticides in the last one year; who are below
18 years; migrants; who have debilitating illness; and those who were not willing to
participate in the study.
3.6 Sample size
Sample size was estimated by Open epi version 3.01. According to a study done in
Kuttanad, 78 percent of the pesticide applicators had reported adverse health effects due to
pesticide spraying.22
Taking 78 percent as the anticipated prevalence of acute pesticide
poisoning, with 95% confidence interval, precision 6% and design effect 1.5, sample size
was estimated to be 275. In order to have equal number of applicators from every cluster
(96 clusters), sample size was raised to 288.
3.7 Sample selection procedure
Multi stage cluster sampling was done for this study. Among the ten taluks of Kuttanad
area, Kuttanad taluk was purposively chosen as it had the maximum area of paddy
cultivation. From the selected taluk, six villages were randomly selected using lottery
method. The identified villages were Champakkulam, Nedumudy, Pulinkunnu,
Ramankary, Kainakari and Veliyanad. Sixteen clusters (padashekharams*) were
randomly selected from each village. From each cluster, three pesticide applicators were
selected.
*Padashekharam- “Collection of field or other areas of lands, with or without a common outer
bund, which is suitable for the adoption of a common cultivation programme or common
agriculture” (The Kerala Land Development Act, 1964)
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3.8 Data collection procedure
Data was collected using a structured interview schedule with questions designed to
assess their pesticide use behavior, awareness regarding pesticide use and potential acute
health effects due to spraying. WHO Field surveys of exposure to pesticides standard
protocol was used as a guide to frame the questions. Murphy’s method of Farmer self-
surveillance system of pesticide poisoning is a tool by which farmers can self report the
signs and symptoms of pesticide poisoning following spraying. According to this,
pesticide applicators can be classified as asymptomatic, mild, moderate or severe acute
pesticide poisoning in the past one year.
The questionnaire was translated into local language (Malayalam) and back translated till
the back translated version matched the original version. The instruments were content
validated by an agricultural officer and one occupational health expert. This was pretested
with fifteen pesticide applicators in Kuttanad area who did not participate in the final
survey. After making corrections, the final interview schedule was prepared. The whole
data was collected by the principle investigator herself. A written informed consent was
obtained from each participant before the interview. On an average, it took half an hour to
get an interview completed by the applicator. Along with this, a photograph as well as
observation of the prevailing pesticide use practice was done. The survey was conducted
during 15th
June-15th
September, 2014.
Details about the type of pesticides used, their chemical family, active ingredients and
regulatory status in the State were identified from package of recommendations given by
Kerala Agricultural University.69
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3.9 Data collection process:
From each of the six villages, list of fields along with the contact number of secretary in
charge of each field was obtained from Agriculture offices of the concerned villages. A
local person from each village was employed daily to locate the fields. The secretary in
charge of each field was contacted to get the list of pesticide applicators spraying in their
fields. Subjects were then randomly selected from the list.
Table 3.9 Summary of the final sample recruitment process
Number of taluks 1
Number of villages 6
Number of clusters/padashekharams 96
Applicators from each cluster 3
Applicators eligible to participate 288
Applicators willing to participate 270
Applicators interviewed 270
3.10 Variables under the study
3.10.1 Definition of the variable
Subject: Pesticide applicator who has sprayed pesticides in Kuttanad for paddy cultivation
in the last one year
3.10.2 Operational definition of the variable
Category 1 health effects - insomnia, red eyes, burning/stinging/itchy eyes, excessive
tearing, runny nose, excessive salivation, burning nose, sore throat, cough, numbness,
itchy skin, sweating, skin rashes [redness, white rash, cracks/scales, blisters, dryness],
muscle weakness, short of breath, headache, exhausted and dizziness
Category 2 health effects - twitching eyelids, blurred vision, vomiting, chest pain, nausea,
stomach cramps, diarrhea, staggering gait, muscle cramps and tremor.
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Category 3 health effects - seizure and loss of consciousness
Asymptomatic - if no signs and symptoms are present.
Mild acute poisoning – if only category 1 health effects are present
Moderate acute poisoning – if at least one effect of category 2 is present
Severe acute poisoning – if at least one of the effect of category 3 is present
3.10.3 Outcome variable
Acute pesticide poisoning: FAO of the United Nations Integrated Pest Management
Programme for Asia (FAO/IPM) has adopted a simple means for the farmers to self report
any signs and symptoms if occurring during the spraying session or within 24 hours. The
Murphy’s method has a total of 29 symptoms out of which 18 are category 1 effects, 10
are category 2 effects and 2 are category 3 effects. Based on these symptoms in various
categories, classification is done for acute poisoning.
3.10.4Predictor variable definitions
3.10.4.1 Individual characteristics: Age, sex, educational status
Age: Age in completed years was recorded as reported by the applicator.
Educational status – Education was classified into five categories such as: upto 4 years of
schooling, 5-7 years of schooling, 8-10 years of schooling, pre degree, diploma and
graduation.
3.10.4.2 Occupational characteristics: Details such as their primary occupation, number
of years of spraying pesticides, number of hours spent for spraying in a day, total area of
paddy field sprayed per day in acres were collected.
3.10.4.3 Pesticides used: Applicators were asked to enumerate the pesticides they had
sprayed in the last one year, to which they reported the trade names of chemicals. Type of
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chemical, active ingredients, chemical family of pesticides, physical formulation,
regulatory status of chemical in the State and WHO toxicity category was obtained from
the document provided on the website of Department of agriculture, Government of
Kerala.69
Type of chemical – Chemicals were classified into herbicide, insecticide or fungicide.
Physical formulation – Chemicals were classified into solids or liquids.
Regulatory status of chemicals in the state – Chemicals were checked with the document
on ‘list of chemicals banned in the State’ published by Department of agriculture ,
Government of Kerala70
WHO toxicity category – Chemicals were classified into WHO toxicity levels such as Ia,
Ib, II, III and IV.12
3.10.4.4 Pesticide mixing behavior: The solvent which is used to mix the active
ingredients, the mode of mixing, equipment used to mix the ingredients and the spraying
equipment were found out.
3.10.4.5 Pesticide use practice: Disposal of left over solution, disposal of empty
containers, storage of pesticides were detailed.
3.10.4.6 Personal hygiene and sanitation practices: Practices such as washing hands,
changing clothes after spraying, eating and drinking water at workplace, smoking or
consuming alcohol at the workplace were asked to the participant.
3.10.4.7 Personal protective measures: Prescribed personal protective equipments
includes mask with replaceable filter, rubber gloves, goggles, rubber boots. Clothing
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20
consists of hat, full sleeve shirt and full pants. Local measures which they adopted were
also enquired.
3.10.4.8 Co-morbidities: The existence of any underlying co-morbidities were self
reported by the respondent.
3.10.4.9 Knowledge about spraying: Knowledge about the WHO colour codes and
hazard symbol, source of information about spraying, formal training received were asked.
Knowledge about WHO colour codes and hazard symbol – A set of pictograms of colour
codes and hazard symbol were shown to the applicators to define them.
3.10.4.10 Perception about health risk – Applicators’ risk perception about unsafe use of
pesticide was assessed using a set of six comments to which they said whether they agree
or not.
3.11 Plan for dissemination
A report out of this study will be submitted to the Department of Agriculture and
Department of Health & Family Welfare, Government of Kerala as well as to the
Agricultural Officer, Kuttanad. The findings will be shared with Centre for Occupational
and Environmental Health, New Delhi and published in scientific peer reviewed journals.
3.12 Data storage and data cleaning
The data were coded and entered in Epidata manager version 2.0. Data was cleaned in
Microsoft Excel 2007 and statistical analysis done using IBM SPSS version 21. The hard
copies of interview schedule are stored in a locked chamber under my vigilance. The
privacy and confidentiality of subjects was further maintained by analyzing the data and
reporting the results without the identifiers of the applicators and their respective areas.
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3.13 Data analysis and statistical methods
The data analysis for the quantitative process includes sample characteristics and bivariate
analysis. Univariate descriptive were expressed as frequencies with their percentages. Chi
square tests were used to find the association between pesticide poisoning and potential
risk factors. Fischer’s test was adopted when any of the cell in the table had value less
than five. p value of less than 0.05 was considered to be significant.
3.14 Expected outcomes
Prevalence of acute pesticide poisoning among pesticide applicators, pesticide use practice
as well as the type of pesticides sprayed in Kuttanad can be identified at the end of the
study.
3.15 Ethical considerations
Ethical clearance was obtained from Technical Advisory Committee (TAC) and
Institutional Ethics Committee (IEC) of Sree Chitra Tirunal Institute for Medical Sciences
and Technology (Ref No: SCT/IEC/607/JUNE-2014). Informed written consent was
obtained from every participant at the start of interview. They had the freedom to
withdraw or not answer the questions at any point of time. The identity of each of the
participants was kept confidential by use of dummy ID numbers in place of name in the
data entry sheet. Verbal consent was obtained from the participants when photographs
were taken. Photographs in which applicator’s face was visible, it was blurred so as to not
reveal their identity. The applicators who suffered from APP were advised on how to
reduce the exposure. Since the data collection was carried out during the rainy season,
spraying was not being done and so none of the applicators were suffering from any
symptoms of acute poisoning. (Refer Annexure V)
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CHAPTER – 4
RESULTS
The findings of the descriptive study done among the pesticide applicators in the paddy
fields of Kuttanad from June 15th
to August 31st, 2014 are presented in this chapter. The
analysis was done in accordance with the primary objective of describing the pesticide use
behaviour among applicators in Kuttanad area. The secondary objectives were to find out
the acute health effects among applicators and also to assess their awareness regarding
pesticide use. The final sample had 270 applicators achieving a response rate of 93.7
percent.
4. Sample characteristics
A total of 270 applicators participated in the study. There were eighteen non respondents.
Major reasons for non – response was unwillingness due to lack of time (14 applicators)
and inability to contact four as they had gone to work elsewhere.
4.1 Profile of the study population
All the respondents were males.. The mean age was 51.79 years (SD=8.2). The youngest
applicator among them was 31 years old and the oldest 72 years. Maximum number of
applicators belonged to the age group 50-60 years. Fifteen percent were above the age of
60 years.
There were no illiterates among the applicators and nearly 60 percent had completed 10
years of schooling.
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Variable n (%)
Age group
60 years 41 (15.2)
Education
Upto 4 years of schooling 17 (6.3)
5 - 7 years of schooling 85 (31.5)
8 - 10 years of schooling 158 (58.5)
Pre degree 4 (1.5)
Diploma 6 (2.2)
4.2 Occupational characteristics
Pesticide spraying was carried out by most of the respondents as a secondary occupation
in addition to other wage earning jobs in the rice fields of Kuttanad. About two-thirds also
did other farming activities, 19 percent engaged in manual labour and 3.7 percent also did
inland fishing in the backwaters. Pesticide spraying was reported as the primary
occupation by only seven percent of the respondents. About one fourth of the respondents
had been carrying out the pesticide spraying job for more than 30 years while half of the
respondents were in the job for 20-30 years. A considerable proportion reported that they
work for more than 4 hours a day during the season. Nearly 90 percent of applicators
spray more than 3 acres (300 cents/121 ares) in a day.
Table 4.1 Profile of the study population
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Variable n (%)
Main occupation of applicators
Pesticide spraying 17 (6.3)
Farming 173 (64.07)
Labour 52 (19.3)
Fisherman 10 (3.7 )
Boat service 6 (2.2)
Shop keeper 3 (1.1)
Auto driver 3 (1.1)
Others* 6 (2.2)
Years of service in pesticide spraying
< 10 years 30 (11.1)
10-20 years 53 (19.6)
20-30 years 130 (48)
>30 years 57 (21.1)
Number of hours working with pesticide in
the field per day
4 h 173 (64.1)
Days per year spent in the field
30 d 11 (4.1)
Area sprayed per day (in acre)
5 32 (11.9)
*Others – tailor, motor pumping business
Table 4.2 Occupational characteristics of the study population
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4.3 Type of pesticides used
All applicators reported the trade names of pesticides and were not aware about their
scientific names. In total, they reported 45 different commercial brands of pesticides that
corresponded to 28 active ingredients belonging to 16 chemical families. Most of the
formulations were liquid in nature. The most often used pesticide (58 %) as reported by
the applicators was 2, 4-D (2,4-Dichlorophenoxyacetic acid).
Monocrotophos and Methyl parathion (organophosphorous insecticides) and Paraquat
dichloride (bipyridylnium herbicide) which has been banned and restricted respectively70
for rice crop were reported to be in use by the applicators in the past 12 months. The main
categories of pesticides used were herbicides followed by insecticides and fungicides.
Majority applicators (60%) reported that they used pesticides belonging to pyramidinyl
thio benzoate and organophosphates family. Four respondents sprayed chemical belonging
to extremely hazardous category.
Variable n (%)
Category of pesticides used*
Herbicide 243 (90)
Insecticide 201 (74.4)
Fungicide 104 (38.5)
Banned/restricted pesticides sprayed by applicators*
Monocrotophos 4 (1.6)
Methyl parathion 1 (0.4)
Paraquat dichloride 37 (13.8)
WHO Hazard classification of the pesticides used*
Applicators who used class Ia/extremely hazardous 4 (1.5)
Applicators who used Class Ib/highly hazardous 210 (77.8)
Applicators who used Class II/moderately hazardous 250 (92.6)
Applicators who used Class III/slightly hazardous 9 (3.3)
* Multiple options possible
Table 4.3 Pesticides used by the applicators
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4.4 Methods of pesticide mixing
About 93 percent mixed the desired dose of active ingredient with water in separate
containers. Wooden sticks were the most common tool used for mixing purpose (85%).
About 50 percent reported that they used their hands to mix the pesticides. Among them,
92 percent used their bare hands and use of gloves while mixing was reported by a mere
eight percent. The equipment used to spray was the knapsack sprayer. More than 90
percent sprayed with manual knapsack sprayer while 20 percent used knapsack mist
blower - duster machine that was motorised.
26.7
13.8
1.1
0.4
47.4
6.7
7.8
60.4
58.5
60.7
18.5
37.8
31.5
0 20 40 60 80
Aryloxy phenoxy propionate
Bipyridylnium
Benzimidazole
Chloroacetanilide
Diamide
Fiprole
Neonicotinoid
Organophosphate
Phenoxyacids
Pyramidinyl thiobenzoate
Pyrethroid
Sulfonylureas
Azole
Percentage of applicators sprayed
Chemical
family of
pesticides
Figure 4.3 Chemical natures of pesticides used by applicators
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Variable n (%)
Mix pesticides in*
Separate container 250 (92.6)
Sprayer itself 20 (7.4)
Mixed using*
Stick 230 (85.2)
Hands 129 (47.8)
Hands without gloves 119 (44.1)
Hands with gloves 10 (3.7)
Pour between containers 6 (2.2)
Aluminium spoon 1 (0.4)
Head of nozzle of sprayer 2 (0.7)
Type of pesticide applicator*
Manual backpack sprayer 248 (91.9)
Automated backpack sprayer 56 (20.7)
* Multiple options possible
4.5 Source of knowledge about spraying
About three fourths of the pesticide applicators practice the spraying based on their own
experience. Nearly 40 percent cited pesticide sellers as the main source of information.
About a third relied on government agriculture department. Others gathered information
primarily through advertisements in the media, fellow applicators and owners of the paddy
fields. Only a negligible number had undergone training on proper spraying techniques
and related facts. Training was received either from the government department for
agriculture or dealers of pesticide manufacturing companies.
Table 4.4 Mixing of pesticide contents
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Variable n (%)
Source of information about pesticide use*
Own experience 197 (73)
Agricultural officer 82 (30.4)
Pesticide seller 105 (38.9)
Fellow pesticide applicators 27 (10)
Advertisements 4 (1.5)
Owners of fields 13 (4.8)
Training regarding pesticide use* 35 (13)
Agricultural office 26 (74.3)
Pesticide dealers 9 (25.7)
* Multiple options possible
4.6 Knowledge about pesticide colour codes and hazard symbol
About 90 percent reported that they had seen the WHO colour codes for pesticides on
the product packages. However, about 80 percent were not aware of the significance
or the toxicity level that each colour code is associated with. About 98 percent were
aware about the hazard symbol and 92 percent interpreted it as danger sign.
Variable Have seen: n (%) Rightly interpreted : n (%)
Colour codes* 243 (90) 54 (20)
Red colour 247(91.5) 126 (46.7)
Yellow colour 242 (89.6) 63 (23.3)
Blue colour 243 (90) 55 (20.4)
Green colour 240 (88.9) 62 (23)
Hazard symbol 266 (98.5) 248 (91.9)
* Multiple options possible
Table 4.5 Source of knowledge about spraying
Table 4.6 Knowledge about colour code and hazard symbol
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4.7 Perception about health risks
Almost all of the applicators agreed to the statement that pesticides are poisonous and that
it could cause adverse effects on human health. A vast majority were unaware of the long
term effects of pesticide use. About 70 percent of the respondents perceived that a person
could develop immunity against them if they used pesticides for many years. More than
two-thirds agreed with the statement that pesticide residues in will not lead to death. Only
a quarter agreed with the statement that pesticide containers can be reused after cleaning
for other purposes.
Perception Agree Do not agree Not sure
Pesticides are poisonous 270 (100) 0 0
Pesticide causes adverse effect on human health 268 (99.3) 2 (0.7) 0
Using small amount of pesticides for a long time
is not harmful for a person’s health
216 (80) 45 (16.7) 9 (3.3)
After using pesticide for a number of years, a
person can develop immunity to pesticides
182 (67.4) 62 (23) 26 (9.6)
Pesticide residue in food will not result in death 165 (61.1) 88 (32.6) 17 (6.3)
Pesticide containers can be reused after cleaning 61 (22.6) 201 (74.4) 8 (3)
4.8 Pesticide use practice
More than three quarter of applicators reported left over solutions were not kept at the end
of each day’s spraying; it was always mixed according to the exact quantity required. Five
Table 4.7 Perception about health risks
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30
percent applicators said that they kept the leftover solution saved for the next application.
Four percent claimed that they poured the remaining solution to the nearby stream.
More than half of the applicators disposed the empty containers in the farm site itself or
sold them to the scrap dealers after proper rinsing. Less than five percent reported
throwing into nearby stream, burning or burying them. One applicator used the empty
containers as floaters for his fishing net and boat. Some applicators handed over them to
their owners as a proof of finishing spraying work.
With regard to storage, majority took care to store them in a separate shed outside the
house. Less than five percent reported storing inside the house. Less than 10 percent
reported that they did not store pesticides as they obtained it from the owners or they used
the pesticide immediately after purchasing it.
Variable n (%)
Disposal of left over pesticide solution*
None 233 (86.3)
Saves for next application 14 (5.2)
Disposed to stream 11 (4.1)
Apply to same crop although not needed 9 (3.3)
Applied to other plants 3 (1.1)
Disposal of empty pesticide containers*
Selling to scrap dealers 137 (50.7)
Burning 11 (4.1)
Burying 4 (1.5)
Left in farm place 155 (57.4)
Submitted to owner 24 (8.9)
Thrown into nearby stream 7 (2.6)
Used as floater for boat and fishing nets 1 (0.4)
Table 4.8 Pesticide use practice
Continued....
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Variable n (%)
Storage of pesticides*
Inside the house
Bedroom 4 (1.5)
Bathroom 5 (1.9)
Separate room in home 2 (0.7)
At the roof of house 2 (0.7)
Outside the house
Shed 144 (53.3)
At backside of home 12 (4.4)
Within the courtyard 5 (1.9)
Bought and used on same day 24 (8.9)
* Individuals responded to more than one category
4.9 Personal Protective Behaviour
None of the applicators wore the complete suggested personal protective equipment
(PPE). It includes goggles, face masks with replaceable filters and rubber gloves. Eight
percent applicators wore at least any one prescribed PPE. The adoption of proper safety
measures such as goggles and apron was found to be less than 5 percent. Nearly 10
percent used hat, mask or rubber gloves. Mask with replaceable filter weren’t owned by
any of the respondents.
Mask was not preferred by many as they reported having breathing difficulty or
discomfort during hot and humid climate when wearing mask. Out of the applicators who
used towel on their face during spraying, 21 percent used it only when there is offensive or
when powdery pesticides are mixed in windy conditions. About 21 percent reported that
they did not use PPE since they were not provided with any by the stakeholders. None of
them wore shoes since it made walking difficult in the shallow puddles in which rice is
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grown. They also reported that the shoes gets loosened and wet after wearing for some
time. Economic constraint was cited as a factor by three applicators. Nearly 32 percent felt
there was no need to wear PPE.
Table 4.9.1 Personal protective behaviour
Protective measure Always n (%) Occasionally n (%)
Clothing
Full sleeved shirt 209 (77.4) 33 (12.2)
Hat 13 (48) 4 (1.5)
Full pants 107 (39.6) 142 (52.6)
Personal protective equipments
Goggles 3 (1.1) 4 (1.5)
Mask with replaceable filter 0 0
Rubber gloves 6 (2.2) 12 (4.4)
Apron 1 (0.4) 0
Local means to adapt
Towel (face) 15 (5.6) 57 (21.1)
Cotton mask 6 (2.2) 18 (6.7)
Towel (head) 42 (15.6) 50 (18.5)
Socks (legs) 23 (8.5) 0
Socks (hands) 115 (42.6) 0
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Variable n (%)
Reason for not adopting PPE
Discomfort 120 (44.4)
Feels that there is no need to wear 86 (31.9)
Not aware about PPE 3 (1.1)
As no one provides 58 (21.5)
Economic constraints 3 (1.1)
Reason for occasional use of protective measure
Protective measure on head (n=54)
Only in scorching sun 52 (96.3)
Not used when the wind blows 2 (3.7)
Protective measure on face (n=76)
Only if the pesticide is granular in nature 2 (2.6)
Only when wind blows while spraying 36 (47.3)
Whenever the company provided masks 1 (1.3)
Only when power sprayers are used 2 (2.6)
Only for noxious smelling pesticides 35 (46.05)
Protective measure on eyes (n=4)
Only during wind 2 (50)
Only with pesticides that are strong irritants 2 (50)
Protective measure on hands (n=12)
Only if pesticides are strong irritants 9 (75)
Only with the grown paddy plants that has serrated edges 3 (25)
Protective measure on legs (n=142)
Only with the grown paddy plants that has serrated edges 141 (99.3)
Only when herbicides are sprayed 1 (0.7)
Table 4.9.2 Reason for non – compliance towards protective measures
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4.10 Personal hygiene and sanitation practices
After spraying, nearly all of the applicators washed their hands with soap and water as
well as changed their clothes right after work. About a quarter of the respondents reported
that they consumed food during their work with pesticides. More than 90 percent drank
water while spraying. Thirteen percent of applicators smoked during work while five
percent reported the habit of drinking alcohol while spraying.
Hygiene practices n (%)
Wash hands 270 (100)
Change clothes 269 (99.6)
Eat at workplace 73 (27)
Drink at workplace 244 (90.4)
Smoke at workplace 37 (13.7)
Consume alcohol at workplace 13(4.8)
4.11 Co-morbidities among the applicators
Amongst the respondents, 30 percent said they suffer from other co-morbidities. About 13
percent suffered from hypertension, eight percent from hypercholesterolemia and six
percent from asthma. Many had morbidities associated with musculoskeletal system.
Table 4.10 Personal hygiene and sanitation practices
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Variable n (%)
Chronic disease 81 (30)
Asthma 16 (5.9)
Hypertension 35 (13)
Diabetes 25 (9.3)
Hyper cholesterolemia 22 (8.1)
Heart disease 5 (1.9)
Musculoskeletal problems 6 (2.2)
4.12Acute pesticide poisoning (APP)
About 62 percent applicators reported the occurrence of pesticide poisoning in the past 12
months. Nearly 57 percent suffered from mild and 6 percent suffered moderate APP. Only
a negligible proportion (5%) among the affected applicators visited a health care provider
for the treatment. Among them, all preferred allopathic system of medicine. The most
frequent self reported toxicity symptoms include itching of skin, blister on skin, twitching
of eyelids and itching of eyes.
Variable n (%)
Acute pesticide poisoning in the past one year
Asymptomatic 102 (37.7)
Mild poisoning 153 (56.7)
Moderate poisoning 15 (5.6)
Severe poisoning 0
Table 4.11 Co-morbidities
Table 4.12.1 Acute pesticide poisoning
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36
Table 4.12.2 Signs and symptoms reported
Variable n (%)
Nicotinic symptoms
Muscle weakness 1 (0.4)
Twitching of eyelids 2 (0.7)
CNS symptoms
Fatigue 6 (2.2)
Staggering gait 1 (0.4)
Tremor 5 (1.9)
Insomnia 9 (3.3)
Muscarinic symptoms
Headache 5 (1.9)
Blurred vision 10 (3.7)
Shortness of breath 6 (2.2)
Cough 1 (0.4)
General signs
Skin itching 105 (38.9)
Itching of eyes 43 (15.9)
Runny nose 13 (4.8)
Skin blister 86 (31.9)
Nasal irritation 4 (1.5)
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4.13 Bivariate analysis
Acute pesticide poisoning was considered as the outcome variable. Bivariate analysis
was done to find out the factors associated with pesticide poisoning. p value less than
0.05 was considered to be significant.
4.13.1 Bivariate analysis of socio demographic characteristics with APP
Age and hours of spraying were found to be significantly associated with APP.
Applicators aged more than 60 years had a lower proportion of APP cases. Those who
sprayed for more than 4 hours in a day had higher number of poisonings.
Table 4.13.1 Bivariate analysis- socio demographic characteristics with APP
Variables (N=270) APP n (%) p-value
Age
60 years (n=41) 18 (43.9)
Education
1-4 years of schooling (n=17) 9 (52.9)
5-7 years of schooling (n=85) 53 (62.4) 0.375
8-10years of schooling (n=158) 102 (64.6)
>10 years of education (n=10) 4 (40)
Hours of spraying
< 2 hours (n=4) 2 (50)
2-4 hours (n=93) 49 (52.7) 0.049
>4 hours (n=173) 117(67.6)
Continued....
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Variable n (%)
Days of spraying in a year
< 15 days (n=123) 121 (61.4)
15-30 Days (n=136) 39 (62.9) 0.791
>30 days (n=11) 8 (72.7)
Years of spraying pesticides
< 20 years (n=83) 52 (62.7)
20 – 30 years (n=130) 81 (62.3) 1.0
>30 years (n=57) 35 (61.4)
Area of field sprayed per day
< 3 acres (n=45) 23 (51.1)
3 – 5 acres (n=193) 121 (63) 0.15
>5 acres (n=32) 24 (72.7)
4.13.2 Pesticides used associated with APP
Insecticides and fungicides were found to be significantly associated with APP. Those
who sprayed these chemicals had more APP cases.
Variables (N=270) APP n (%) p-value
Insecticides*
Yes (n=201) 136 (67.7) 0.002
No (n=69)
32 (46.4)
Fungicides*
Yes (n=104) 74 (71.2) 0.017
No (n=166) 94 (56.6)
Herbicides*
Yes (n=243) 148 (60.9) 0.213
No (n=27) 20(74.1)
* Multiple options possible
Table 4.13.2 Bivariate analysis -Type of pesticides used with APP
Continued....
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4.13.3 Bivariate analysis -pesticide mixing behaviour with APP
The manner in which the applicators mixed the active ingredients was found to be
significantly associated with APP. Those who used many containers to mix as well as
those who used their bare hands to mix the active ingredients had a higher proportion of
poisoning cases. Applicators who sprayed with power sprayers had more APP cases.
Variables (N=270) APP n (%) p value
Mixed in*
Sprayer itself (n=20) 5 (25) 0.001
Separate containers (n=250) 163 (65.2)
Mixed using bare hands*
Yes (n=119) 85 (71.4) 0.008
No (n=151) 83 (55)
Mixed using stick*
Yes (n=230) 145 (63) 0.59
No (n=40) 23 (57.5)
Manual knapsack sprayer*
Yes (n=248) 149 (60.1) 0.02
No (n=22) 19 (86.4)
Knapsack mist blower-dust sprayer*
Yes (n=56) 42 (75) 0.03
No (n=214) 126 (58.9)
* Multiple options possible
4.13.4 Bivariate analysis of personal protective measures with APP
Use of personal protective measures such as rubber gloves, towel on face and cotton
gloves were found to be significantly associated with APP. Those who adopted any form
of protective behaviour had a lower proportion of poisoning cases.
Table 4.13.3 Bivariate analysis of pesticide mixing behaviour with APP
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Protective measure APP n (%) p value
Goggles
Yes (n=7) 4 (57.1) 1.0
No (n=263) 164 (62.4)
Cotton mask
Yes (n=24) 14 (58.3) 0.826
No (n=246) 154 (62.6)
Rubber gloves
Yes (n=18) 6 (33.3) 0.012
No (n=252) 162 (64.3)
Towel on face
Yes (n=72) 33 (45.8) 0.0001
No (n=198) 135 (68.2)
Cotton gloves
Yes (n=23) 8 (34.8) 0.006
No (n=247) 160 (64.8)
4.13.5 Bivariate analysis - personal hygiene and sanitation practices with APP
Eating at workplace was found to be significantly associated with APP. Although not
significant, applicators who practised drinking water, smoking and consuming alcoholic
beverages at workplace had a higher proportion of acute poisoning cases.
Variable APP n (%) p value
Eats at workplace
Yes (n=73) 53 (72.6) 0.035
No (n=197) 115 (58.4)
Drinks water at workplace
Yes (n=244) 156 (63.9) 0.09
No (n=26) 12 (46.2)
Smokes at workplace
Yes (n=37) 23 (62.2) 1.0
No (n=233) 145 (62.2)
Consumes alcohol at workplace
Yes (n=13) 11 (84.6) 0.14
No (n=257) 157 (61.1) 0.14
Table 4.13.4 Bivariate analysis - personal protective measures with APP
Table 4.13.4 Bivariate analysis of personal hygiene and sanitation practices with APP
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4.14 Photographs obtained from the study area so as to document the
pesticide use practice, mixing behaviour, storage and disposal of
pesticide containers
4.14.1Spraying equipment:
4.14.2 Pesticide mixing behaviour
Figure 4.14.1.1 Knapsack mist blower – duster machine
(motorised)
Figure 4.14.1.2 Manual knapsack sprayer
Figure 4.14.2.1 Measurement cup Figure 4.14.2.2 Pouring the active
ingredient of pesticide into the
measurement cup
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Figure 4.14.2.3 Pouring the active
ingredient into a container
Figure 4.14.2.4 Pouring water into the
container with active ingredient
Figure 4.14.2.5 Mixing the ingredients with
wooden stick Figure 4.14.2.6 A half-cut container
used to collect water for mixing
Figure 4.14.2.6 Applicator pours water
into the sprayer
Figure 4.14.2.7 Lid of the spraying
machine is tightly closed
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4.14.3 Personal protective behaviour
4.14.4 Disposal of empty containers
Figure 4.14.3 Applicator sprays in the paddy field without wearing any personal protective
equipment. Even the clothing such as hat, full sleeve shirt, full pants are not used. The towel on the
face is also not tied properly while spraying increasing the exposure.
Figure 4.14.4.1 Empty containers lying in
the stream
Figure 4.14.4.2 Empty containers stored
at the back side of applicator’s home
Figure 4.14.4.3 Scrap dealer collecting empty containers from the Kuttanad area
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4.14.5 Storage of pesticides
4.14.6 Personal hygiene and sanitation practices
Figure 4.14.5.1 Pesticides hung from the roof Figure 4.14.5.2 Pesticides stored in a closed shed
Figure 4.14.5.3 Pesticides stored in an open shed
Figure 4.14.6.1 Applicator spraying bare feet
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4.14.7 Source of information
Figure 4.14.7 Advertisement of a herbicide pasted on a wall near the fields
Figure 4.14.6.2 Applicator putting mud over his
hands so as to wash away the smell of
chemicals
Figure 4.14.6.3 Applicator washing his hands in
the stream
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CHAPTER – 5
DISCUSSION
The salient findings of the study are discussed in this chapter.
5.1 Socio demographic characteristics
The study found that the pesticide spraying in the paddy fields of Kuttanad, Kerala was
carried out by males exclusively. Similar observation was reported from West Bengal
indicating clear sex based work differentiation in agricultural labour.66
Pesticide
application in the paddy fields were carried out by males while females engaged in other
agricultural activities such as weeding, planting, reaping etc. However this is in contrast to
other countries like China, where majority of pesticide applicators were women.71
The age distribution in the current study found that majority of the applicators was middle
aged and older. Fifty six percent were above the age of fifty. It was also interesting to find
that the youngest applicator was 31 years old. According to the applicators, the younger
generation in Kuttanad was reluctant to engage with this work. Many of them indicated to
the researcher that there was a negative perception and a certain kind of stigma prevalent
in the community against them for engaging in such a risky occupation.
5.2Work characteristics
All the applicators however were involved in some occupation other than pesticide
spraying. The most frequent mentioned were farming, daily manual labour and fishing.
This pattern seems to be similar in other parts of the country as indicated out in the study
carried out in West Bengal.66
Most of them were engaged in spraying for 20 years and
more. The range of experience in spraying was from 2 years to 58 years. Generally,
applicators spray for two seasons such as ‘puncha season’ and ‘additional crop season’ in
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a year for paddy crops in Kuttanad. In certain areas, they adopt farming only for one
season as the fields would be water-logged due to rain since they are below sea level.
5.3 Pesticides use behaviour
The primary objective of the study was to describe the pesticide use behaviour among the
pesticide applicators of Kuttanad area. The main pesticides used belonged to herbicides
(90%) followed by insecticides (74%). This is comparable with global but contrasts the
Indian scenario whe