Economic burden of illness from pesticide poisonings in highland Ecuador

Mitigation of pesticide-mediated ocular toxicity via nanotechnology-based contact lenses: a review

The xenobiotic stress exerted by pesticides leads to the deterioration of human and animal health including ocular health. Acute or prolonged exposure to these agricultural toxicants has been implicated in a number of pathological conditions of the eye such as irritation, epiphora or hyper-lacrimation, abrasions on the ocular surface, and decreased visual acuity. The issue is compounded by the fact that tissues of the eye absorb pesticides faster than other organs of the body and are more susceptible to damage as well. However, there is a lacuna in our knowledge regarding the ways by which pesticide exposure-mediated ocular insult might be counteracted. Topical instillation of drugs known to combat the pesticide induced toxicity has been explored to mitigate the detrimental impact of pesticide exposure. However, topical eye drop solutions exhibit very low bioavailability and limited drug residence duration in the tear film decreasing their efficacy. Contact lenses have been explored in this respect to increase bioavailability of ocular drugs, while nanoparticles have lately been utilized to increase drug bioavailability and increase drug residence duration in different tissues. The current review focuses on drug delivery and futuristic aspects of corneal protection from ocular toxicity using contact lenses.

Relationships among Production Systems, Preschool Nutritional Status, and Pesticide-Related Toxicity in Seven Ecuadorian Communities: A Multi-Case Study Approach

Background

Among small Andean potato farmers, greater pesticide use and better linkage to markets are promoted as ways to improve farm outputs and incomes. The health of household members is assumed to improve with higher incomes, although evidence to support such an assumption remains scarce.

Objective

Using a multidisciplinary approach, we sought to characterize agricultural systems producing potatoes and to assess relationships between these characteristics and farm household health indicators.

Methods

We included seven communities linked to a regional agricultural potato production platform (socio-organizational “space” for potato commercialization) in Chimborazo, Ecuador. The unit of analysis was the community, each of which was classified according to its level of intensity of potato production as more intensive, intermediate, or less intensive. Data on crop management, household food intake, child anthropometry, and impacts of pesticide use on adult health were collected by survey.

Results

The net income from potato production was similar in communities with more intensive and intermediate production systems and lower in those with less intensive systems. However, deficits in protein intake were more common among children in communities with more intensive systems (63%) than among those in communities with intermediate (53%) and less intensive (37%) systems. Deficits in thiamin and riboflavin intake were more prevalent in communities with more and less intensive systems than in those with intermediate systems. In contrast, the prevalence of moderate chronic malnutrition, as measured by height-for-age, was greater among children in communities with less intensive systems (27%) than among those in communities with intermediate (5%) and more intensive (7%) systems. Across all intensities, frequent use of highly hazardous pesticides was associated with adverse health effects.

Conclusions

Agricultural development programs need to work more cross-sectorally to realize the potential health benefits associated with intensification of production.

A Review of Bioinsecticidal Activity of Solanaceae Alkaloids

Only a small percentage of insect species are pests. However, pest species cause significant losses in agricultural and forest crops, and many are vectors of diseases. Currently, many scientists are focused on developing new tools to control insect populations, including secondary plant metabolites, e.g., alkaloids, glycoalkaloids, terpenoids, organic acids and alcohols, which show promise for use in plant protection. These compounds can affect insects at all levels of biological organization, but their action generally disturbs cellular and physiological processes, e.g., by altering redox balance, hormonal regulation, neuronal signalization or reproduction in exposed individuals. Secondary plant metabolites cause toxic effects that can be observed at both lethal and sublethal levels, but the most important effect is repellence. Plants from the Solanaceae family, which contains numerous economically and ecologically important species, produce various substances that affect insects belonging to most orders, particularly herbivorous insects and other pests. Many compounds possess insecticidal properties, but they are also classified as molluscides, acaricides, nematocides, fungicides and bactericides. In this paper, we present data on the sublethal and lethal toxicity caused by pure metabolites and crude extracts obtained from Solanaceae plants. Pure substances as well as water and/or alcohol extracts cause lethal and sublethal effects in insects, which is important from the economical point of view. We discuss the results of our study and their relevance to plant protection and management.

The Pesticide Metabolites Paraoxon and Malaoxon Induce Cellular Death by Different Mechanisms in Cultured Human Pulmonary Cells

Organophosphorus (OP) pesticides are known to induce pulmonary toxicity in both humans and experimental animals. To elucidate the mechanism of OP-induced cytotoxicity, we examined the effects of parathion and malathion and their respective metabolites, paraoxon and malaoxon, on primary cultured human large and small airway cells. Exposure to paraoxon and malaoxon produced a dose-dependent increase in cytotoxicity following a 24-hour exposure, while treatment with parathion or malathion produced no effects at clinically relevant concentrations. Exposure to paraoxon-induced caspase activation, but malaoxon failed to induce this response. Since caspases have a major role in the regulation of apoptosis and cell death, we evaluated OP-induced cell death in the presence of a caspase inhibitor. Pharmacological caspase inhibition protected against paraoxon-induced cell death but not malaoxon-induced cell death. These data suggest that caspase activation is a key signaling element in paraoxon-induced cell death, but not malaoxon-induced cellular death in the pulmonary epithelium.

Comparison of international guidelines of dermal absorption tests used in pesticides exposure assessment for operators

The number of farmers who have suffered from non-fatal acute pesticide poisoning has been reported to vary from 5.7% to 86.7% in South Korea since 1975. Absorption through the skin is the main route of exposure to pesticides for farmers who operate with them. Several in vitro tests using the skins of humans or animal and in vivo tests using laboratory animals are introduced for the assessment of human dermal absorption level of pesticides. The objective of this study is to evaluate and compare international guidelines and strategies of dermal absorption assessments and to propose unique approaches for applications into pesticide registration process in our situation. Until present in our situation, pesticide exposure level to operator is determined just using default value of 10 as for skin absorption ratio because of data shortage. Dermal absorption tests are requested to get exposure level of pesticides and to ultimately know the safety of pesticides for operators through the comparison with the value of AOEL. When the exposure level is higher than AOEL, the pesticide cannot be approved. We reviewed the skin absorption test guidelines recommended by OECD, EFSA and EPA. The EPA recommends assessment of skin absorption of pesticides for humans through the TPA which includes all the results of in vitro human and animal and animal in vivo skin absorption studies. OECD and EFSA, employ a tiered approach, which the requirement of further study depends on the results of the former stage study. OECD guidelines accept the analysis of pesticide level absorbed through skin without radioisotope when the recovery using the non-labeled method is within 80~120%. Various factors are reviewed in this study, including the origin of skin (gender, animal species and sites of skin), thickness, temperature and, etc., which can influence the integrity of results.

Epidemiology and 'developing countries': writing pesticides, poverty and political engagement in Latin America

The growth of the field of global health has prompted renewed interest in discursive aspects of North-South biomedical encounters, but analysis of the role of disciplinary identities and writing conventions remains scarce. In this article, I examine ways of framing pesticide problems in 88 peer-reviewed epidemiology papers produced by Northerners and their collaborators studying pesticide-related health impacts in Latin America. I identify prominent geographic frames in which truncated and selective histories of Latin America are used to justify research projects in specific research sites, which nevertheless function rhetorically as generic 'developing country' settings. These frames legitimize health sector interventions as solutions to pesticide-related health problems, largely avoiding more politically charged possibilities. In contrast, some epidemiologists appear to be actively pushing the bounds of epidemiology's traditional journal article genre by engaging with considerations of political power, especially that of the international pesticide industry. I therefore employ a finer-grained analysis to a subsample of 20 papers to explore how the writing conventions of epidemiology interact with portrayals of poverty and pesticides in Latin America. Through analysis of a minor scientific controversy, authorial presence in epidemiology articles, and variance of framing strategies across genres, I show how the tension between 'objectivity' and 'advocacy' observed in Northern epidemiology and public health is expressed in North-South interaction. I end by discussing implications for postcolonial and socially engaged approaches to science and technology studies, as well as their relevance to the actual practice of global health research. In particular, the complicated interaction of the conflicted traditions of Northern epidemiology with Latin American settings on paper hints at a far more complex interaction in the form of public health programming involving researchers and research participants who differ by nationality, ethnicity, gender, profession, and class.

Reducing Pesticide Exposure and Associated Neurotoxic Burden in an Ecuadorian Small Farm Population

The contribution of community-based interventions, including farmer field schools (FFSs) in integrated pest management (IPM), to reducing pesticide exposures and associated neurotoxic burden among small-farm families in Ecuador was assessed in three Andean farming communities in a co-design of targeted action-research. Baseline questionnaire surveys elicited pesticide-related knowledge, practices, and exposure and neurobehavioral assessments were done using an adapted WHO battery. Pesticide applications on plots farmed by FFS versus non-FFS participants were compared. A year later, repeated surveys of participating households (n = 29) and neurobehavioral testing of individuals (n = 63) permitted comparisons of pre- and post-intervention values. The FFS graduates applied pesticides on their plots less frequently (p = 0.171). FFS households had increased pesticide-related knowledge of labels and exposure risk factors (both p < 0.004), better pesticide-handling practices (p < 0.01), and less skin exposure (p < 0.01). Neurobehavioural status had improved, particularly digit span and visuo-spatial function, resulting in overall z-score increases. Thus, community interventions reduced pesticide use, reported skin exposure, and neurotoxic burden among smallholder farm families.

Economic burden of acute pesticide poisoning in South Korea

OBJECTIVES

To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea.

METHODS

The total costs of APP from a societal perspective were estimated by summing the direct medical and non-medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non-medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre-mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature.

RESULTS

In 2009, a total of 11,453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100,000 population and a mortality rate of 2.6 per 100,000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre-mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small.

CONCLUSION

Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre-mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP.

Modelo de desenvolvimento, agrotóxicos e saúde: um panorama da realidade agrícola brasileira e propostas para uma agenda de pesquisa inovadora

O modelo agrário hegemônico no Brasil está baseado em monocultivos para exportação que são intensivos em tecnologias mecanizadas e no uso de agrotóxicos. O país tornou-se o principal consumidor mundial de agrotóxicos e é avaliado como o mercado que mais crescerá num futuro próximo. Este trabalho teve como propósito fazer uma avaliação geral da relação entre o modelo agrário brasileiro e os impactos à saúde e ao ambiente decorrentes do uso de agrotóxicos e propor uma agenda de pesquisa para subsidiar o enfrentamento dos problemas apontados que integre os setores comprometidos com a defesa da saúde, do meio ambiente e da segurança e soberania alimentar. Constatou-se e discutiu-se a necessidade de: dar maior visibilidade aos efeitos e aos custos socioambientais e de saúde do modelo predominante; utilizar instrumentos econômicos para incentivar o uso de tecnologias mais limpas e modelos de produção mais saudáveis, compatíveis com a agricultura familiar, e para desestimular os modelos que oferecem mais riscos à saúde e ao ambiente; desenvolver e implementar políticas públicas baseadas em referenciais da economia ecológica e da agroecologia, com a participação de movimentos sociais, das instituições reguladoras e de grupos de pesquisa.

Uso de agrotóxicos e impactos econômicos sobre a saúde

OBJETIVO: Estimar externalidades associadas às intoxicações agudas por agrotóxicos. MÉTODOS: Foram estimadas as probabilidades de intoxicação aguda segundo as características dos estabelecimentos rurais e de municípios no Paraná. Foram utilizadas informações sobre intoxicações agudas obtidas da Pesquisa de Previsão de Safras de 1998 a 1999. Os custos esperados com a intoxicação nessas propriedades foram calculados a partir da soma das despesas médicas-hospitalares e dos dias de convalescência necessários para restabelecer a saúde dos intoxicados. Foi construído um modelo multinível para análise. RESULTADOS: O custo associado à intoxicação aguda pode representar até US$ 149 milhões para o Paraná, i.e., para cada dólar gasto com a compra dos agrotóxicos no estado, cerca de US$ 1,28 poderiam ser gerados em custos externos com a intoxicação. Essa situação poderia ser revertida com a implementação de políticas públicas, como adoção de programa de incentivo à agricultura orgânica nos municípios, cujo custo social com a intoxicação aguda poderia ser reduzido em torno de US$ 25 milhões. CONCLUSÕES: A sociedade, em especial as populações mais atingidas pelos agrotóxicos, seriam beneficiadas se riscos de intoxicação aguda associados ao atual modelo de produção agrícola fossem reconhecidos e eliminados. É necessária a implementação de políticas públicas e ações integradas envolvendo os campos da economia, da saúde pública, da agronomia, do meio ambiente, da educação e da ciência e tecnologia, dentre outros.

Knowledge and practices of farmers with reference to pesticide management: implications on human health

A study was conducted to assess the knowledge and practices of Ethiopian farmers about pesticide management: implications for human health. A pretested standardized questionnaire was administered. The results revealed that the great majority 174 (99.4%) farmers had ample awareness about pesticide impact on human health. However, various hazardous practices have also been documented. One hundred thirty-five (77.2%) farmers make use of the empty pesticide containers for various household purposes. The most frequent self-reported toxicity symptoms associated with pesticide use were headache (58.8%), salivation and vomiting (38.2%), nausea (36.5%), and sneezing (12.5%). Chi-square analysis revealed a strong association between the farmer's educational status and reported toxicity symptoms (p = .0001; χ(2) = 498.2; df = 30). Creating awareness about safe usage of pesticide is extremely vital by special orientation programs. Besides, promoting alternative pest control strategies such as use of biopesticides and integrated pest management (IPM) could be productive.

An agriculture and health inter-sectorial research process to reduce hazardous pesticide health impacts among smallholder farmers in the Andes

BACKGROUND

The use of highly hazardous pesticides by smallholder farmers constitutes a classic trans-sectoral 'wicked problem'. We share our program of research in potato and vegetable farming communities in the Andean highlands, working with partners from multiple sectors to confront this problem over several projects.

METHODS

We engaged in iterative cycles of mixed methods research around particular questions, actions relevant to stakeholders, new proposal formulation and implementation followed by evaluation of impacts. Capacity building occurred among farmers, technical personnel, and students from multiple disciplines. Involvement of research users occurred throughout: women and men farmers, non-governmental development organizations, Ministries of Health and Agriculture, and, in Ecuador, the National Council on Social Participation.

RESULTS

Pesticide poisonings were more widespread than existing passive surveillance systems would suggest. More diversified, moderately developed agricultural systems had lower pesticide use and better child nutrition. Greater understanding among women of crop management options and more equal household gender relations were associated with reduced farm pesticide use and household pesticide exposure. Involvement in more organic agriculture was associated with greater household food security and food sovereignty. Markets for safer produce supported efforts by smallholder farmers to reduce hazardous pesticide use.Participatory interventions included: promoting greater access to alternative methods and inputs in a store co-sponsored by the municipality; producing less harmful inputs such as compost by women farmers; strengthening farmer organizations around healthier and more sustainable agriculture; marketing safer produce among social sectors; empowering farmers to act as social monitors; and using social monitoring results to inform decision makers. Uptake by policy makers has included: the Ecuadorian Ministry of Health rolling out pesticide poisoning surveillance modeled on our system; the Ecuadorian Association of Municipalities holding a national virtual forum on healthier agriculture; and the Ecuadorian Ministry of Agriculture promulgating restrictions on highly hazardous pesticides in June 2010.

CONCLUSION

Work with multiple actors is needed to shift agriculture towards greater sustainability and human health, particularly for vulnerable smallholders.

Resource concentration dilutes a key pest in indigenous potato agriculture

Modern restructuring of agricultural landscapes, due to the expansion of monocultures and the resulting elimination of non-crop habitat, is routinely blamed for rising populations of agricultural insect pests. However, landscape studies demonstrating a positive correlation between pest densities and the spatial extent of crop monocultures are rare. We test this hypothesis with a data set from 140 subsistence farms in the Andes and find the inverse correlation. Infestations by the Andean potato weevil (Premnotrypes spp.), the most important pest in Andean potato agriculture, decrease with increasing amounts of potato in the landscape. A statistical model predicts that aggregating potato fields may outperform the management of Andean potato weevils by IPM and chemical control. We speculate that the strong pest suppression generated by aggregating potato fields may partly explain why indigenous potato farmers cluster their potato fields under a traditional rotation system common in Andean agriculture (i.e., "sectoral fallow"). Our results suggest that some agricultural pests may also respond negatively to the expansion of monocultures, and that manipulating the spatial arrangement of host crops may offer an important tool for some IPM programs.

Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

OBJECTIVE

To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district.

METHODS

Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were prospectively collected over a one-month period from one general hospital (2005) and five peripheral hospitals (2006) in the Anuradhapura district. Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals. The cost of the inputs in United States dollars (US$), using 2005 figures, was derived from hospital accounts.

FINDINGS

The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital and maintenance costs. The average total cost of treatment was highest for self-poisoning with pesticides (US$ 49.12). The patients placed in the intensive care unit, who comprised 5% of the total, took up 75% of the overall treatment cost for all self-poisoned patients at the general hospital. The average total cost of treating self-poisoned patients at peripheral hospitals was US$ 3.33. The average patient cost per transfer was US$ 14.03. In 2006, the total cost of treating self-poisoned patients in the Anuradhapura district amounted to US$ 76,599, of which US$ 53,834 were comprised of pesticide self-poisonings. Based on the total treatment cost per self-poisoned patient estimated in this study, the cost of treating self-poisoned patients in all of Sri Lanka in 2004 was estimated at US$ 866,304.

CONCLUSION

The cost of treating pesticide self-poisonings may be reduced by promoting the use of less toxic pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services.

Probabilistic assessment of acute health symptoms related to pesticide use under intensified Nepalese agriculture

Agriculture intensification has pushed farmers to use pesticides for maintaining agricultural productivity and to increase income. However, pesticide use has a significant negative impact on farmers' health. In Nepal, uses of pesticides have been already documented in agriculturally intensified areas, however, little is known on health impacts. Weekly interviews were conducted during 2005 to assess the emerging pesticide problems, estimate the magnitude of pesticide-related acute illness, and identify associated risk factors. The study showed that very few farmers have adopted safety gear during pesticide spraying. The safety measures regression shows that warm temperature and drinking habits significantly reduced adoption of safety gear, whereas, integrated pest management (IPM) training and farm experience increased its adoption. The dose-response analyses showed that use of insecticides or fungicides, spray duration and mixing pesticides significantly affect farmer's health, which could be reduced either by educating farmers, increasing the use of safety gear, or reducing mixtures applications.

Health costs from short-term exposure to pesticides in Nepal

Household surveys were undertaken every week for seven months in 2005 to understand acute health symptoms and to estimate health costs associated with pesticide exposure in rural Nepal. The cost-of-illness and avertive action approach was used to estimate costs of pesticide use. The probit regressions fit sickness and avertive actions with exposure to pesticides and other factors. Based on data from 291 households, the study finds that the magnitude of exposure to insecticides and fungicides significantly influenced the occurrence of acute symptoms. The predicted probability of falling sick from pesticide-related symptoms is significantly higher among individuals who apply pesticides compared to individuals in the same household who are not directly exposed. Further, the predicted annual cost of illness as a result of pesticide use is estimated to be Nepalese Rupees 144 per individual. This cost is nearly one-third of the total expenditure on health care services, but is small compared to the increase in farm production costs, thus when faced with a choice between the health care costs and increases in farm production costs, the individual opts for pesticides. However, the costs are nearly eight times higher compared to the population who were not directly exposed. This study suggests that there are acute health impacts of pesticide use; however, because of the low level of the health costs, farm workers may underestimate the effects of pesticides on the human being, and thus they may continue to use pesticides without any safety precautions.

The global distribution of fatal pesticide self-poisoning: systematic review

BACKGROUND

Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown.

METHODS

We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990-2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning.

RESULTS

We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm.

CONCLUSION

Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

Canada's International Development Research Centre's eco-health projects with Latin Americans: origins, development and challenges

BACKGROUND

Since its founding in 1970, Canada's International Development Research Centre (IDRC) has supported research by concerned Latin American researchers on environments and human health relationships. Framing of such relationships has changed through different periods.

METHODS

Participant observation, bibliographic searches, document review, and interviews with key IDRC staff.

FINDINGS

From the early years of multiple different projects, IDRC developed more focussed interest in tropical diseases, pesticides, agriculture and human health in the 1980s. The United Nations Conference on Sustainable Development in the early 1990s gave impetus to examination of links between ecosystems and human health or "EcoHealth". Projects in Latin America built on earlier work but extended it in methods (transdisciplinarity, community participation, gendered approach) and scope (broader land use and development paradigm issues tackled). A key IDRC-funded activity in Latin America was "EcoSalud", an Ecuadorian effort, which has worked with farming communities, agricultural researchers, health practitioners and local politicians to advance integrated pest management, better recognize and treat poisonings and improve pesticide-related policies. ONGOING CHALLENGES INCLUDE: mobilizing sufficient resources for the primary prevention focus of EcoHealth activities when primary care infrastructure remains stretched, promoting micro-level change in diverse communities and ecosystems, and addressing power structures at the global level that profoundly affect environmental change.

Epidemiology of acute organophosphate poisoning in hospital emergency room patients

Acute organophosphate (OP) poisoning is a major health issue in developing countries. Organophosphate insecticides inhibit cholinesterase (ChE) enzymatic activity, thereby eliciting cholinergic signs and symptoms. Victims of OP poisoning require immediate hospital emergency room (ER) treatment to prevent a fatal outcome. We present an epidemiologic review of acute OP poisoning in hospital ER patients. Areas of interest include countries with acute OP poisoning, nature of exposure, gender and age of patients, clinical cholinergic features, ChE activity, and health outcome, including recovery rate, case fatality rate, and post-ER complications. The review comprises case reports, hospital surveys, and clinical studies on acute OP poisoning. More studies were conducted in developed than in developing countries. Suicidal and occupational OP poisoning in agricultural workers was prevalent in developing countries, whereas accidental OP poisoning was prevalent in developed countries. Healthcare workers in the ER were also affected by OP poisoning. Both males and females were affected. Children accounted for 35% of the OP-poisoned victims. Patients presented with a classic cholinergic syndrome and serum ChE depresssion, with a recovery rate above 90%. Neurologic impairment was the most frequent complication. Preventing environmental OP exposure and increasing the awareness of pesticide toxicity would reduce acute OP poisoning and protect human health.

Suicide and exposure to organophosphate insecticides: cause or effect?

BACKGROUND

Suicide using pesticides as agent is recognized as a major cause of pesticide poisoning.

METHODS

A literature review of mortality and morbidity studies related to suicide among pesticide-exposed populations, and of human and animal studies of central nervous system toxicity related to organophosphate (OP) pesticides was performed.

RESULTS

Suicide rates are high in farming populations. Animal studies link OP exposure to serotonin disturbances in the central nervous system, which are implicated in depression and suicide in humans. Epidemiological studies conclude that acute and chronic OP exposure is associated with affective disorders. Case series and ecological studies also support a causal association between OP use and suicide.

CONCLUSIONS

OPs are not only agents for suicide. They may be part of the causal pathway. Emphasizing OPs solely as agents for suicide shifts responsibility for prevention to the individual, reducing corporate responsibility and limiting policy options available for control.

Reducing acute poisoning in developing countries—options for restricting the availability of pesticides

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts.

Pesticide Use among Farmers in the Amazon Basin of Ecuador

Pesticide use is one of the most significant occupational exposures for agricultural workers in the Amazon basin of Ecuador. A structured questionnaire was developed focusing on sociodemographic characteristics, knowledge and experience of adverse health effects related to pesticide use, details of work practices, and an inventory of pesticides used on the farm. Of the 112 farmers interviewed, 111 (99.1%) used pesticides. Paraquat was most commonly used (77.4%), followed by glyphosate (65.7%). Respondents had good knowledge about the acute health effects of pesticides and their exposure routes. Risk behaviors were identified as frequent pesticide use, washing pesticide equipment in water sources used by humans, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. Training and educational campaigns on pesticide use should be encouraged for this cohort, along with suggestions for alternative methods of pest control.

Pesticide usage and health consequences for women in developing countries: out of sight, out of mind?

Pesticide exposures of women in developing countries are aggravated by economic policy changes associated with structural adjustment programs and globalization. Women in these countries, particularly in the agricultural sector, are increasingly exposed. Since they are concentrated in the most marginal positions in the formal and informal workforces, and production is organized in a gender-specific way, opportunities for women to control their exposures are limited. Data from developing countries show that: 1) women's exposures to pesticides are significantly higher than is recognized; 2) poisonings and other pesticide-related injuries are greatly underestimated for women; 3) for a given adverse outcome from exposure, the experience of that outcome is gender-discriminatory; 4) erroneous risk perception increases women's exposures. The hiatus in knowledge of gender-specific exposures and effects is related to gender biases in the nature of epidemiologic inquiry and in the literature, and the gendered nature of health workers' practices and surveillance. Recommendations are made for strong, independent organizations that provide opportunities for women to control their environments, and the factors affecting their health, as well as gender-sensitive research to address the particularities of women's pesticide exposures.