Original arh'cle

KNOWLEDGE, ATTITUDE, AND PRACTICE (KAP) OF USING PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR CHILLI-

GROWING FARMERS IN HUARUA SUB-DISTFUCT, MUEANG DISTRICT, UBONRACHATHANI PROVINCE, THAILAND

Saowanee Norkaewl, Wattasit Siriwongl, 2,

Sumana Siripattanakul3, and Mark Robson2~4~ 5

1 College of mtblic Health Sciences, Chulalongkorn University, Bangkok, Thailand 2 Thai Fogarty ITREOH Center, Chulalongkorn University, Bangkok, Thailand

3 Faculty of Engineering and National Center of Excellence for Environmental and Hazardous Waste Management, Ubon Ratchathani University, Ubonratchathani, Thailand

4 School of Environmental and Biological Sciences, Rutgers University, New Brunswick, N J , USA 5 UMDNJ-School of Public Health, Piscataway, NJ, USA

ABSTRACT: Pesticide use in Thailand has increased significant, raising concerns about potentially adverse effects on human health and environment, in particular, as a number of pesticide products have been heavily used on chilli farms. The objectives of this study were: (1) to assess the knowledge, attitudes, and practices on using personal protective equipment (PPE) of chilli-growing farmers to protect themselves from pesticides, (2) to evaluate the knowledge, attitudes, and practices associated with pesticide use and exposure in the chilli-growing farmers, and (3) to provide recommendations and guidelines to reduce the exposure to pesticides among farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province, Thailand. A standardized questionnaire was completed through face to face interviews with 330 chill-growing farmers. The results showed that 53% of the participants were male and 39.6% and ages ranging between 31-40 years. 71.2 % had received primary school education and most of them applied pesticides by themselves. Almost 89.4% of respondents acknowledged that they ought to wear mask, boots, and cloth while spraying. Furthermore, 83.3% knew that pesticides can pass through their body in 3 ways; ingestion, dermal contact, and inhalation. In addition, 45.5% of respondents knew that spraying should be done in the windward direction and that they should use PPE. Many of the respondents checked their equipment before using them and wore clothing while spraymg. Nevertheless, 77.2 % of chilli-growing farmers had low level of knowledge, 54.5 % of the farmers were not concerned about pesticide use or exposure, and 85.0 % of farmers demonstrated a fair level of actual usage. The associations between knowledge and attitude, knowledge and practice, and attitude and practice demonstrated statistical significance with low positive correlation (0.2 16, 0.285, and 0.305 respectively,). The results suggested that government authorities and communities should be provided with the appropriate recommendations, strategies and guidelines to prevent adverse health effects regarding to pesticide exposure of farmers in this area. Keywords: Knowledge, Attitude and Practice (KAP), Pesticide, Personal Protective Equipment (PPE), Thailand

INTRODUCTION: Pesticides are widely used 80,000 tons in 2004. The majority of imported throughout the world, especially in agriculture pesticides in recent years were herbicides, for crop protection, especially within a n insecticides, fungicides, and plant growth agricultural country such as Thailand, regulators. In Asia, Thailand ranked fourth in Approxjmately 40% of the country's area is annual pesticide consumption. The average agriculture and comprises 60% of the total pesticide use is very high and Thailand is the national workforce'). In order to encourage country with the thrd kghest pesticide use rate, agncultural production, farmers used large following Korea and Malaysia21. Even though amounts of agrochemicals including fertilizers pesticides increases crop it has effects on and pesticides. T h d a n d has increased the human health. An important problem related to amount of pesticides imported with agriculture is pesticide poisoning. In 2008, approximately 21,000 tons in 1994 to over highest number of illnesses was from pesticide

* To whom correspondence should be addressed. E-mail: wattasit.@chual.ac.th Tel. 662-2188231

J Health Res 20 70, 24(~"pppi 2): 93- 100

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poisoning and account for 79.63 % of total occupational diseases31. Health Systems Research Institute (2005) reported that Thai farmers are at risk due to pesticide poisoning because of inappropriate pesticide use, incorrect use of PPE and a lack of understanding regarding pesticide toxicity4). Normal misuse of pesticides usage included amounts or concentrations exceeding that recommended, mixing various pesticides together, inappropriate use of PPE while mixing or applying pesticides, improper disposal of pesticides, and a lack of awareness and knowledge.

Ubonrachathani Province is located in the northeast region of Thailand with average temperatures in the dry season (October to Apnl) of 24.69'C. Of a total area of 16,112 km2, 10,577.66 km2 is used for crop cultivation and vegetations). Ubonrachathani produced various agricultural products such as rice, cassava, c m , and rubber trees with a hgh usage of crop protection and cultivation agents6).

The objectives of this study was to assess the knowledge, attitude and practice on using personal protective equipment, to evaluate the knowledge, attitudes, and practices (KAP) associated with pesticide use and exposure in cm-growing farmers, and to provide recommendations and guidelines to reduce pesticide exposure among chilli-growing farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province, Thailand. MATEFUALS AND METHODS: This was a cross sectional study knowledge, attitude, and practice (KAP) of using personal protective equipment (PPE) among ch&-growing farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province. The study population was concentrated on farmers who use pesticides to control pest in chilli farms and included 330 farmers that apply pesticides on their farms. The majority were farm owners that have controlled and mixed volume of pesticide and sprayed pesticide by themselves. This study calculated sample size from population sizeq. The farmers were selected by convenient sampling in this area; were more than 18 years of age, included men and women who were not pregnant.

The measurement tool used was by rno-g a standardized questionnaire that had been previously used among tangerine farmers in a pesticide safe use project89 9, '0 ) . It sought to assess the knowledge, attitude and practice on using personal protective equipment of chilli- growing farmers. The questionnaire consisted of the following five parts: (1) socio-demographic characteristics, (2) information regarding

pesticide use, (3) knowledge regarding use of PPE to limit pesticide exposure, (4) attitude towards pesticide usage and PPE, (5) practice on using pesticide and PPE.

RESULTS: The ages of participants ranged from 24 to 70 years old, with an average age of 42 years. The majority of the participants were male (53.00%), couple (87.9 %), and head of family (51.5%). In this study, 71.2% of respondents graduated from primary school and 57.6% of the respondents had an income less than 50,000 baht. Approximately 84.8% of the respondents were farm owner and 75.8 % of respondents owned less than 3 rais or 1.19 acres of land. Table 1 demonstrates the general profile sample population.

Table 1: Socio-demographic characteristics Characteristics Number %

Age (years) 5 30 35 10.5 3 1-40 130 39.6 41-50 105 3 1.9 51-60 40 12.0 >60 20 6.0 Mean 2 SD = 42.0 + 10.7 Range= 24 to 70 Gender Male 175 53 Female 155 47 Marital status Single 35 10.6 Couple 290 87.9 Widow 5 1.5 Status in family Head of family 170 51.5 Spouse 110 33.3 Child 25 7.6 Parent 5 1.5 Occupant 20 6.1 Education Never 10 3.0 Primary school 235 7 1.2 Secondary school 50 15.2 High school 30 9.1 Bachelor's degree 5 1.5 Income (Baht/ year) < 50,000 190 57.6 50,001-150,000 95 28.8 150,001-300,000 40 12.1 >300,001 5 1.5 land owner (1 rai = 1,600 sqm2) < 3 rais 215 65.2 3-5 rais 100 30.3 5-7 rais 15 4.5 Property relationship Owner 280 84.8 Renter/Employee 50 15.2

J Health Res 20 10, 24(11tppI 2): 93-100

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When examining problems that respondents

encountered during growing crops, 84.8% listed

insects as the main problem, flowed by weed

(60.6%) and plant disease (74.2%). Furthermore,

47% of participants claimed that they applied

abamectin, 23.3% applied selecron (profenofos),

and 14.9% used podium600 (chlorpynfos)

14.9% to their crop. Typical pesticide

applications included self-spraying (8 1 .Bolo).

Although 77.3% of the respondents claimed that

they did not have any chronic diseases, when

assessing symptoms associated with pesticide

use, results revealed that 57,6% never showed

any symptoms while 39.4% showered few

symptoms of headache, fatigue, dizziness,

stomach cramps, and throat irritation. In

addition, 48.5% of respondents claimed that in

the past 12 months, they had taken a

cholinesterase test with normal results while

34.8% had never checked.

Furthermore, when farmers felt dl from

pesticide use the same amount of participants

went to health centers as relied on themselves

(23.3%). On the other hand, 20% of respondents

went to district hospital and alternative

medicine. Participants typically obtained

information regarding pesticide use from

agricultural officer ( 17.89%) or television

(1 5.75%). Table 2 demonstrates mformation

regarding problems of weeds, insects, and

pesticide use.

Table 2: Information regarding problems of weeds, insects, pesticide use of participants Characteristics Number % Insect problem Yes 280 84.8 No 50 15.2 Weed problem Yes 200 60.6 No 130 39.4 Plant disease problem Yes 245 74.2 No 85 25.8 Animal problem Yes 15 4.5 No 315 95.5 Common pesticide used Abamectin (abamectin) 155 47.0

Characteristics - % Selecron (profenofos) 77 23.3 Podium 600 (chlorpynfos) 49 14.9 Paraquat (paraquat) 30 9.1 h a t e (carbamate) 10 3.0 Other 9 2.7 Pesticide Application* Apply by self 270 81.8 Apply by hired applicator 60 18.2 Congenital disease Congenital disease 75 22.7 Never 255 77.3 Toxicity symptom Never 190 57.6 Few symptom 130 39.4 Moderate symptom 10 3.0 How to treat Toxicity symptom associated with pesticide* By themselves 77 23.33 Herbal use by themselves 62 18.79 Alternative medicine 27 8.18 Health center 77 23.33 Private clinic 18 5.46 District hospital 32 9.70 Provincial hospital 37 11.21 Snxce of pesticide inf~~nation* Radio 41 12.42 TV 52 15.75 Document/ article 42 12.72 Broadcast tower 28 8.48 Neighbor 33 10.00 Agricultural office 59 17.89 Public health office 7 2.12 Pesticide salesman 48 14.56 Community header 7 2.12 Health volunteer 13 3.94 Have you had a cholinesterase test in the last 12 months? Never 115 34.8 Yes but not know result 20 6.1 Yes and normal 160 48.5 Yes and not normal 30 9.1 Yes with health effects 5 1.5

*multiple choices

The average knowledge score among respondents was 6.48 (SD=2.64) whereas scores ranged between 2 to 11 with 70% of respondents receiving scores ranging between 2 to 9. The item with the highest amount of correct responses was to the question, 'When you were spraying pesticide, what is the proper practice?" in which 89.4% respondents recognized that they should use mask, wear

boots, and wear proper attire that covers their body entirely. Many respondents (83.3%) knew that the pesticides can pass through their body

J Health Res 20 10,24(Sz,~pI2): 93- I00

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accumulated in soil, water, air and vegetables &dice the jirst aid 190 57.6

that were sprayed. Furthermore, they were in case of acute

via 3 routes; ingestion, dermal contact and inhalation. About 71% of respondents knew that the pesticides were contaminated and

Correct Knowledge items Number '10 13.Whatisthesymptomoflongte1m 200 60.6 dcidem?

More than half of them (57.6%) followed the recommended amount when spraying pesticides, cleaned equipment with detergent,

showered and immediately changed their clothes after pesticide spraying. In addition, 47% of respondents were concerned about the manufacturer and expiration dates, selecting pesticides based on the desired type of pest erahcation. Approximately, 26% of them knew that pesticides were hannful to all living things and were aware that drinking pesticides by

- -

aware that long term pesticides exposure symptoms causes dizziness and feel dry (60.6%).

I

*negative statement

The results demonstrated that 77.2% of respondents had a low level of knowledge, 22.8% of them had a moderate level, while none of the farmers demonstrated a high level of knowledge of using PPE. The results can be found in Table 4.

Table 4: Distribution of knowledge levels of using PPE

mcide? 15. Howto~cesthefirstaid 85 25.8 + , i,,,ofdrinkdcide?

Knowled e level Low level (160%) Moderate level (60%-80%) Hi level 81%- 100°h

accident could cause vomiting. About 20% of to table 5, appmximately 38% of them knew about the toxicity and harmfulness

respondents considered pesticides harmful to of pesticides based on the colors used on pesticide labels, keeping pesticides separately in human health and the environment. They believed

a locked cabinet. L~~~ than 20% mixed that exercise could help excrete toxic pesticide

pesticides in container before filling spraying through sweat while 34.8% were unsure of whether

machines. In addition, they disposed of empty dnnlang water after exposure could help in the same pesticide containers by throwing them away in way. m e r m o r e , 26% of respondents stated that local waste bins. Table 3 demonstrates the using wmd ~ c k to pesticides Mg was safer number of percentages of participants responses

than using their hands and 45.5% of respondents regarding knowledge o pesticide usage. Table 3: Number and percentage of knowledge believed that spraying should be done in the

canpassthroughthebody?What? I respondents believed that they if used more than the

Correct Knowledge items Number % 1. How many routes that the mcides 275 83.3

-

2: What is dkadmntage of pestkde use? :: zB 1 recommended amount of pesticide whde spraying 3. How to use the pesbcide properly? 4. When you want to buy Wdde, 155 47 that it would increase their crop yield. Approximately

windward direction. In addition, 40.9% knew that

they should use PPE during spraying and 36.4% of

How do you consider? 33% were disagreed that pesticide can pass through 5. How to known toxicity of Wcide? 70 21.2 1 6. What is the axrect method of 1 9 ~ 57.6 the body only ingestion. 30.3% of them agree that

Wcide use? I mticide is harmful to insect onlv. Less than 30% of 7. How to proper mix of pesticides? 60 18.2 8.iir~imgWhmisthepest1dde 235 71.2 1 A

the respondents were considered with after spraying

residual? without wearing protective equipment must take a - - - - 9. When you we^ spraying pesbdde, shower as a preventive alternative. Less than 30% of What is the pqxrly practice? 10. What are the pmperly practices the respondents believed that showering was a good afkr @dde used? 11. How to storage the peshcide product?

preventative alternative after spraying pesticides 75 22.7 1

without wearing PPE. Less than 60% of them usually

J Health Res 2010, 2J(supp/ 2): 93- I00

12. How to di- of empty Mcide 50 15.2 containers?

wore boots whde spraying.

Original article

Table 5: Percentages of attitudes towards using PPE of each

SLronghl Agree N e u t d Di=P= Strongty Attitudeitems a p e

Yo Yo 0x7 Yo Yo 1. M d d e can pass through the body only lngeston 9.1 22.7 16.7 33.3 18.2

route * 2. RsticideMtoinsectonly,nothannfulto

human health* 3. Incxax amount of w d d e anyhme of u x to

p r e v e n t h c e * 4. Mix various e c i d e s will incmx effectiveness

and no d i m - * 5. Using w o o d - M to mix the pesticides is safety

than using hand 6. Use pesbcides more than label mommendation

may incmx yield* 7. Ifyou stand windwad directon when spraying

pesticide, donL concern about clothes* 8. Mcides are hamf~~I to the human health and

environment 9. Drink coconut juice after e x p a d mcide for

exaetmg m d d e toxicity* 10. Drink water after exp& &ride f a exaebng

pesbcide toxicity' 1 1. Exerrise can help to excreting pesbcide tcwcity

throughsweat 12. While you arc spraying peshcide, you should not

wear Cl0thE-g thoroughly * 13. Pesticide can residues in a@- prcck~ct and

its harm to caxmmer 14. ~sivechemicalsare~ectivetocontrolpest

bettesthancheapchemicals* 15. If spraying chemical without wearing p r o t h e

equipment, must shower immediately after the spray as a ureventive alternative*

*negative statement

Table 6 demonstrates attitudes towards PPE use.54.5% of respondents were not concerned about using PPE, while 45.5% had a neutral attitude towards PPE use. Table 6: Distnbution of attitude levels towards PPE Attitude level Concern Attitude (8 1%-100%) Neutral Attitude (60%-80%) Not concern Attitude Less than 60% 54.5

Table 7 Illusbates the respondents took showers immedBtely after spraying 75.8% and 74.2% of the washed their hand and face with soap after using pshcides prior to eating. Appmumately 68% of respondents checked eq~~pment pnor to use and 63.6O/0 wore clothes that c o d their entire body. Also 62.1% d d not allow other people or other ammals to be in the vicinity while spraying Wcides. Less than W! of respondents removed their clotlvng or shoes immediately afler spraying.

More than half of respondents usually read the instructions on use prior to use and followed the mmendat ions , wore gloves and a mask when mixing pesticides, and burned or buried the empty pesticide oontainers aflerwards. Less than half of respondents took the time to learn about appropnak type of e c i d e to use, washed the clothes they wore during wearing spraylng irnrndtely & d s , and stocd in the windward direcbon while spraying yet without wearing PPE. Apprmbately 30% of respondents used detergents to clean their phcide containers and 59.1% of respondents h e d to have never mated m c i d e s using their bare hands. In addtion, 53% of respondents had never smoked or drank water whde spraying pesticides. Half of the respondents d ~ d not spray pest~cides when the weather was windy. Less than 550% of respondents threw empty pesticide containers into a river or resen&. Appnximately Wh of respondents d many types of pesticides together in order to increase effdheness.

J Health Res 20 10, 24(supp~ 2): 93- I00

9 8 Original article

Table 7: Percentages of practice towards using PPE Table 8: Distribution of practices towards using PPE

of pesticide 2.Select pesticide by n@tor's xrmmmendd/ alhrhmg/price* 3.Read label before use and fob m e n d a h

4.Check equipment and material before using 5Avodd human and animalhmsprayingam 6.WeargloJesandmask whenmxingpesticides 7.Inhale pesticide for confirmingpestidde* 8 . a pesticide by hand* 9 . a various pesticide for maease decfive radiation *

81 Practice level Good practice (8 1%- 100%) Fair practice (60%-80%) 180 8 5 Poor ractice Less than 60% 30

Knowledge, attitude and practice q a d m g use of PPE were anaIyzed using Spearman's rank correlation dcients. The assmiation between howledge and

attitude, knowledge and pracbce, and attitude and practice demonstrated a low posltive correlation (0.2 16, 0.285, and 0.305 mqxdnely). W e 9: Asmiation among knowledge, attitude, and mctice ofusing PPE

L,

Variables Spearman's rho Coefficient Knowledge & Attitude 0.2 16* howledge & Practice 0.285" Attitude & Practice 0.305* * Correlation was at 0.0 1 level of significance.

tho mu^ 11.Wearboot 59.1 28.8 12.1 0 12.Smo~ordnnkmg* 4.8 9.1 33.3 53.0 1 3 . w ~ pesticide while 1.5 19.7 28.8 50.0 k W 14,Standwindwddirecdon 18.2 19.7 36.4 25.8 while spmyh.1g with out probxtiw equipment*

containers m the river after I used* 16.Dhsp3se pestic.de 1.5 27.3 242 47 coniainen m the w after

used* 17.Cleaning pesticide 25.8 30.3 18.2 25.8 applicators WithdeteIgent before storage 18.RaM-xle&thswhich 59.1 27.3 10.6 3.0 when spraying irnmdateb 19.Washing&thswhile 47.0 28.8 13.6 10.6 we;uing spray immdteiy 2O.Storage pzitlcides in 27.3 22.7 21.2 28.8 cabinets 2 1. Ernpy pesticide 51.5 33.3 4.5 10.6 containers should be burned or buried 22.Wash handandwash 74.2 22.7 1.5 1.5 he with soup befm having meal 23. Shmimm&teiy 75.8 21.2 1.5 1.5 aflersprzlly

*negative statement Table 8 showed the distributions of practioes of

-dents in uslng PPE. While 20% demonstrated god practice, 85% showed f;3ir practice, and finally 6% had p r practice.

Discusion: In this study, the results showed that 53% of the parhcipts were male with the average age of 42 years. More than 70% of respondents were h m 31 to 50 years and most of them were head of

hndy and f m owner. These findings are sirmlar to other research that demonstrated that the average age was 43.6 years and 58.4% of the parhcipants were between the ages of 31 to 50 years old and were farm owners. Other research also revealed that the age

range of people w o r m in cottage industries was between 25 to 40 years77 11). In general, there is a qqlicant difference of F c i d e use between male and fernalel1). In this study, 71.2 % of respondents d e d primary school education, which was in amrdance with a study conducted in Braal where 83.2% of workers had less than 8 years of education? Aim, in another research study underkiken in Nepal data revealed that most of farmers had less than 8 years of education@. The popular pesticides used were

a b a m d , profenofos and chlorpydios. The main problem that farmers encountered was insects (84.8%). Other studies in Thailand found most h e r s used m c i d e s and the most common used were herbicides and insecticides (ch1opynfos)q. Another study reported that about 92% of the inMewees had worked directly with pesticides?. Similarly, 8 1.9% of f&mers were mixing and spy ing pesticides by themselves. A study in Lebanon found that agr icu l tud workers received information xgxchg F c i d e s through oml communication and had poor protective measureslq.

J Health Res 20 10,24 (suppl2): 93- 100

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In this study, the majority of dormation about pesticides was obtained through i n f d sources

such as agncultural officer (17.89%) and television (15.75O), whch is in amdance with a similar study in the field of cottage industries1?. Th~s study found that 89.4% wore masks, protective clothmg and boots, which is slrmlar to another study in Ethiopia that showed that PPE was commonly used on farmsl9. On the other hand, a study in Nepal reported that more than half of the fanners d ~ d not have knowledge regardug PPE1ll. Also, 83.3% mgmzed that the pesticide could be absorbed in three different

ways and was typically through occupational exposure@. Most of respondents were aware that Wcides could be accumulated through soil, water, air and plants, whlch was relatively amsistent with a study h m Gaza Strip@. In addition, more than half of respondents followed directions of pesticide labels, showered and changed imrnedmtely after spraying pesticides, whch was in accordance with research

undertaken in B d that found that most farmers showered after working with Wc ides and followed label instructions as we117; however in Nepal, half of respondents did not shower after spraying and a third wore the same clothes more than once while spra$ngl1). Approximately one- quarter of respondents knew the pesticides were harmful to all h g thmgs, which is dissirmlar to other studies7. 11, Q. Only few respondents knew that the type of pesticide they should use depends on the type of pest they are

atternptung to combat In Nepal, nearly 800/0 of respondents decided themselves on which pesticides to use and more than 70% had low level of

knowledgell]. This was relative with another study in Brad whlch found that growers used highly toxic insecticides7. In addition, respondents considered pesbcides to be harmful to their health and to the environment, whch was consistent with other studies7, 11,12).

Attitude regadng spraying pesticides was similar to a study in Brad wherein farmers were observed and sprayed pesticides in the same direction as the wind73 111. Also, a study undertaken in the Gaza strip reported the symptoms associated with toxic pesticide exposure among farmers were related to concentration of m c i d e s usedo. Most of respondents mmgmed

that pesticides could pass through the body in other ways other than ingestion, such as through dermal

contact and mhalationl3. For attitude towards wearing p r o t e e clothu~g farmers were not aware that h s

was necessary, whch agreed with a study in Ethiopia that reported that respondents were careful wMe working with pesticides, which they believed to be more important than using PPEl9. The respondents chmed that showering would remove pesticides b m contammated body surfaces and most of them did showering after w o r h g with pesticides7, 19.

Respondents d ~ d not demonstrate much concern regardug pesticide use and exposure. This similar to other studies done in Gaza Stnp that reported that farm workers had misconceived notions rgardmg pesticide use and it was h ~ t h e d that this was the cause of decreased PPE use*, 1%. Another study in Thailand reported that less than half of farmers used PPE whde spraying psbcides, washed their hands, showered, or laundered their clothes after ~praymg9~111.

In southern Brad, it was reported that over 50% of the agticulkmd workers used protective equipmentl6).

More than half of respondents d ~ d not smoker drink water while spraying pesticidesl1. '3. In terms of the practice of appropriate methods while spraying pesticides, 85% demonstrated a fair level of proper practice. Some studies in developing countries were similar, especially with qp-ds to protective qpmen t7 . Q. The hgh cost of PPE was mentioned as an important factor in the limited use12, 1S.The association between knowledge and attitude, knowledge and practice, and attitude and practice

demonstrated little positive correlation. Conclusions and recommendations: The results revealed that respondents received primary school education; most of them owning the properties where they worked and used pesticide dmxtly. Common pesticides used during growing season were a h & , pfmofos and chlorpynfos. Typically, respondents received health care services h m a health center and obtained information regardmg pesticide use from agricultural officer. A majority of them knew to use PPE and the routes that psbcide can be absorbed into the body. Most of the respondents demonstrated a low level of knowledp regardug PPE and pesticide use, were mostly not concerned about it, and demonstrated a Ewr level of practice in terms of using PPE.

Therefore, evidence- based methods should be developed that can assess the occupational health risk

J Health Res 20 10, 24 (~rippI 2): 93- 100

Original article

assodated with pesticide use. The intervention tools should be developed for enhancing suitable practice for PPE usage and to improve the accuracy in the information given. Farmers should be trajned in the proper usage of personal protective devices. Based on these lindmgs, appropriate policy should be created in order to increase the knowledge regding the harrml effects of e c i d e s and the importance of using PPE at work. Therefore educational programs should be orgamed to increase awareness by h o l m bahhgs

as well as dstributmg literature regardmg PPE and the hazards of pesticide usage among farmers. Acknowledgement: We would like to thank Thai Fogarty Center (Grant Number 1 D43 TWO07849 Fogarty International Center - National Institutes of Health) for fhll rexarch support And we are appreciated with Dr. Srilert Chotpantarat for field

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J Health Res 20 10, 24(~tpp(2): 93- 100