pesticide use behaviour and potential health risks...

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

i

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

ii

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 Information derived from the published or unpublished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

iii

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

iv

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

v

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

vi

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

vii

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

viii

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

ix

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

x

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

xi

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.

1

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.

2

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

3

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,

4

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

5

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

6

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.

7

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.

8

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,

9

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

10

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

11

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

12

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

13

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.

14

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.

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)

16

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

17

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.

18

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

19

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

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.

21

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)

22

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.

23

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

24

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

25

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

26

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

27

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)


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

28

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)


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)


Table 4.5 Source of knowledge about spraying

Table 4.6 Knowledge about colour code and hazard symbol

29

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

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....

31

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

32

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

33

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

34

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

35

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

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)

37

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....

38

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)


Table 4.13.2 Bivariate analysis -Type of pesticides used with APP

Continued....

39

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)


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

40

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

41

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

42

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

43

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

44

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

45

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

46

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

47

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

pesticide use behaviour and potential health risks...

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