MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY *** - NGUYEN TUAN KHANH Evaluate the impact of pesticide use to farmer’s health in tea cultivating in ThaI Nguyen and the intervention’s effects Speccialty: Social hygiene and Health Organization Code: 62 72 73 15 SUMMARY OF PhD THESIS THAI NGUYEN – 2010 The research was conducted at: THAI NGUYEN UNIVERSITY OF MEDICINE AND PHARMACY Advisors: Prof PhD Do Van Ham Prof PhD Nguyen Van Dip Opponent 1: ………………………………………… Opponent 2: ………………………………………… Opponent 3: ………………………………………… The dissertation will protected in front of State Dissertation Appraisal Council at: Thai Nguyen University of Medical and Pharmacy At… hours on… date………………… month…… year… The information from this dissertation is available at: - National Library - Learning Resource Center, Thai Nguyen University - Library of Thai Nguyen University of Medical and Pharmacy 1 INTRODUCTION Using pesticides is a objective reality and a indispensable action in agricultural production World due to the effects of pesticides (P) is estimated about 39 million people yearly acute poisoning and million people among them with heavy acute poisoning and 220 thousand people yearly dead people all over the world Current situation of poisoning pesticides in Vietnam are still becomes serious According to Ha Minh Trung, Vietnam is estimated that if there are about 11.5 million agricultural households with rate of 18.26 % poisoned chronic by pesticides, the number of chronic poisoning in the country up to 2.1 million The main reason is due to abusing and use and indiscriminate pesticides, particularly 98.0 % due to abuse or mix to times condenser than guide on the package, with 84.17 % to 93.23 % not adequate using personal protective equipment (PPE) when spraying The most pesticides using is in cultivating tea about both quantity and frequency of injection Thai Nguyen has an area of nearly 16,000 hectares of tea, tea cultivation in many areas of remote and disadvantaged areas, socio-economic conditions of underdeveloped, low education level Knowledge, practice about using pesticides is still restrictive, which causes bad effect on human health To contribute for taking care of farmer health cultivating tea and build suitable interfere model with actual condition at these areas, we carry out researching this thesis with a view to: Describe the knowledge, attitude and practice (KAP) of farmer exposure to pesticides Determine disease model and describe some factors related to farmer health in cultivating tea Construction and appreciate of effect of interfere model on human health protection suitably for current conditions in Thai Nguyen 2 Charter DOCUMENT OVERVIEW Pesticides is used spreadingly at every nation in the world with income over USD 30 billion from 2005 1.1 The situation of using pesticides and knowledge, attitude and practice of farmers usually contact with pesticides 1.1.1.The situation of using pesticides Pesticides had existed from ancient period and until19th century, it was used widely but chemical methods at this time have not had big role in agricultural production From the beginning of 20th century to 1960, oganic pesticides was invented and chemicals is used at maximum level and its bad consequences had started causing human and environment The period from 1960 to 1980 had left many bad consequences on environment and community health From 1980s to now, environment protection is paid more attention In Vietnam, pesticides is used from 1957, means the periods of centered – plan economy from 1957 to 1990: importing and distributing pesticides depends on the state Amount of pesticides was not used much, only about 15,000 tons per year Most of them were medicals with so long reserved time or high poison Period from 1990 to now, market economy with available goods and many types is used in timely Amount of pesticides is used for heavy industry increasingly 1.1.2 Knowledge, attitude, practice of person contacting with pesticides Researches show using situation, unsafe pesticides reservation, lack of knowledge in obeying labor protection methods Most farmers is lack of awareness, knowledge, subjective attitude about poison and practice untruthfully 1.2 Effect of pesticides and some of risk factors related to farmer’s health Risk of environment polution: Result for study pesticides at some locals shows that amount pesticides in land, water and food at dangerous level and increasing risk 3 Effect of pesticides on human health includes pernicious and chronic poison 1.3 Some studied intervention models to protect human health when exposure to pesticides has been deployed out in Vietnam The thesis related to this problem is still rare, especially in mountainous areas, highland such as Thai Nguyen Some interfere researches have been carried out at some area in Vietnam: The thesis 11-08 of Ministry of Agriculture and Rural Development in combination with Ministry of Health and Ministry of Defence has implemented from 1996 to 2000 In 2002, Bui Thanh Tam and her parner researched community model for using pesticides safety at a district of low land and a district of Northern highland The subject Job Department of Occupational Health - University Thai Nguyen of Medical and Pharmacy has carried out many thesises related to human health in agriculture labor but it is only at experimental level Until now, no thesis helps to protect farmer health cultivating tea when contacting with pesticides Therefore, carrying out a research to take care of farmers here is very nescessary Charter SUBJECTS AND METHOD 2.1 Subjects 2.1.1 Subjects described - KAP study subjects, examinations assess the actual structure of common diseases and interventions are in direct spray pesticides in the tea growing households, have time for years and tea area about over 1800 m2 - Person investigated and interviewing detail is bosses of pesticides selling shops at Tan Linh commune, People Commitee leader, Chairman of commune farmer Union, Chairman of the Commune Women's Union and some farmers - Audience research is the only toxic products 4 2.2 Place of the research Be carried out at Phuc Xuan commune - Thai Nguyen city and two communes including Phuc Linh & Tan Linh, Dai Tu district, Thai Nguyen province This research is intervention at Tan Linh and controls Phuc Linh commune 2.3 Time of the research: From January 2007 to June 2010 2.4 Research method: Epidemiology research design describes cross-sectional design in combination qualitative and quantitative Participation of community 2.5 Sample size and sampling method 2.2.1 Sample size for descriptive study Describing sample interviews farmer’s knowledge, attitude, practice (KAP) Applying formula calculating sample size basing rate: n = z2(1- α/2) p(1-p)/d2 With given number, n = 385 people Person appreciated is 877 farmers usually contacting with pesticides in 385 households 2.5.2 Sampling intervention studies - The sample size for intervention studies as follows: n = (Z 1- α/2 + Z -β)2 p1 q1 + p2 q2 (p1 - p2 )2 With given number, n = 90.16 (about 91 people) Take extra 20 % like this, sample size for each commune is 119 people 2.6 Research design technique 2.6.1 Describing study Epidemiology research design describes cross sectional design in combination qualitative and quantitative 2.6.2 Intervention study Community intervention with comparison 5 Intervention activities Communications: Combine direct communication with indirect communication with an aim to change behavior Direct communication: Through training time, conference, practice guide Especially, through club activity "Farmers - Small business- Medical staff" Indirect communication: On Media include many kinds and means Examination of patients, drug treatment for some common diseases Advise about health for pesticides user Chapter RESULTS Research 385 persons, we have the following results: 3.1 The current status of KAP about pesticides of tea cultivating farmer in Thai Nguyen (n = 385) Table 3.2 Pesticides using time basing on sex Sex 5-10 years > 10 years n* % n Male 47 12.2 134 34.8 181 47.0 Female 63 16.4 141 36.6 204 53.0 >0.05 Total 110 28.6 275 71.4 385 100 % Total n P % * n = Quantity Table 3.2 shows: Pesticides using time of above person over 10 years 71.4 % Female (53.0 %) is more than male (47.0 %), p > 0.05 6 Table 3.4 Knowledge of weather and wind direction chosen when spraying pesticides No Content Know Unknown n % n % Cool weather 351 91.2 34 8.8 Walking backwards 311 80.8 74 19.2 Downwind 171 44.4 214 55.6 Know fully 114 29.6 271 70.4 Table 3.4 shows: Know spray downwind low rate of 44.4 %, the rate is very low that a full 29.6 % Table 3.8 Know about health conditions to ensure the spray No Health conditions to ensure the spray Know Unknown n % n % Don’t spray when there are sick, pregnant, lactating 333 86.5 52 13.5 Older, children who not go spraying 312 81.0 73 19.0 Periodic health examination 139 36.1 246 63.9 Not spraying over hours/ day, two weeks/phase 98 25.5 287 74.5 Know fully 81 21.0 304 79.0 Table 3.8 shows that rate of farmers with full knowledge is very low (21.0 %) Rate of the elderly and children still use to pesticides (19.0 %) Table 3.12 Pesticides mixed practice No Pesticides mixed practice Yes No n % n % Solider 50 13.0 335 87.0 Estimate 2.1 377 97.9 Mixture a kind 68 17.7 317 82.3 Mixture > two kinds 317 82.3 68 17.7 Exact mixture 67 17.4 318 82.6 Table 3.12 shows that mixture rate of many kinds of pesticides when spraying is very high (82.3 %), rate of farmers exact practice mixed pesticides the guide is very low (17.4 %) Table 3.13 Practice using personal protective equipment Use personal protective equipment No Yes Quantity No % Quantity % Mask 355 92.2 30 7.8 Glove 208 54.0 177 46.0 Protective clothes 263 68.3 122 31.7 Hat 246 63.9 139 36.1 Glasses 46 11.9 339 88.1 Full use 25 6.5 360 93.5 Table 3.13 shows that: rate of farmers spraying and using mask is very high (92.2 %) The lowest rate is glasses use (11.9 %), rate for use all kinds of personal protective equipment is very low (6.5 %) Was guided Not guided Not guided, 16.6% was guided; 83,4% Chart 3.4.Rate buyer's guide seller use pesticide and poisoning prevention Table 3.16 Information supply resource No Information Supply Resource Yes Quantity No % Quantity % Medical staff 263 68.3 122 31.7 Plant Protection Officer 37 9.6 348 90.4 Pesticide seller 226 58.7 159 41.3 Radio 158 41.0 227 59.0 Newspaper 94 24.4 291 75.6 Televisions 223 57.9 162 42.1 Table 3.16 shows that high rate of Information supply resource is Medical staff (68.3 %), pesticides seller (58.7 %) 3.2 Health situation and some factors related to the health of people regularly exposed topesticides - The most muscle symptoms of farmers contacting with pesticides during the last time is nervous system, digest Some popular symptoms such as tiredness (77.9 %), headache (73.1 %), dazzle, vertigo (78.4 % Some disease groups with high rate such as diseases about nose and sore (86.9 %), eyes (84.8 %), bone muscle (63.7 %), skin (40.1 %), etc - The risk is due to: unsafe pesticides mixture, solider pesticides mixture than guide, mix many kinds of pesticides in the spray related to disease nose and throat, increased 2.66 times compared with the correct mixture - The risk to spraying the windward with nose and sore diseases is 2.55 times more than right the wind direction pesticides - The risk of going on with disease due to unsafe medicine mixture is 2.31 times more than right mixture The risk of having eye disease due to spraying wind ward increases 3.27 times more than using glasses 3.3 Results of intervention studies 3.3.1 Intervention activities - Build Project implement leading committee, propose commune People Committee to set up "Farmers - Small business Medical staff" club basing on links between “Farmer – The sale of pesticide – commune Medical staff”, keep the club once three months - Organize three training classes for main officers to take charge of the program, organize 14 training days at village (a day for each village) with 856 participants - Celebrate 02 conference days at commune People Committee with 397 participants 04 training days at the edge - Deliver 1000 books: “Chemicals are used for agriculture and community health” Deliver handout to all 1469 households Propagandizing on media of commune (259 days) 10 - All commune Medical staff are trained again about against pesticides poison Project Steering Committee combining with Commune People's Committee managing pesticide suppliers, vendors - Every month, Management committee meets "Farmers - Small business - Medical staff" to appreciate results and withdraw experiments for activities in month and build next solution Table 3.21 Synthetic training, communication activity No Activity content Subjects Committee Steering Committee Times People 24 381 Steering meeting Communication skills Collaborator, training pesticides seller, commune Medical staff 96 Train for commune Commune officer Medical staff 17 Workshop (session) Commune People committee and study subjects 297 Training at village Farmers 14 856 Practice in the field Study subjects 472 Club activities Club members 208 Activity to protect health when exposure with pesticides - Organize periodical medical examination, advisory and care for human health on using pesticides, discover health problems at farmers exposed to pesticides Keep clinic to discover health problems at Tan Linh commune health station Test quantitative blood samples enzyme cholinesterase 11 - Supply medicine to treat free for patient; advisory and introduction to go to treat heavy diseases - Celebrate summary conference to appreciate effectively model "Farmers - Small business - Medical staff" 3.3.2 Effect of interfere solutions at Tan Linh Table 3.22 Knowledge of Medical staff and pesticide sellers Target Preintervention n % Postintervention n % Medical staff (n = 6) Be trained 0.0 100.0 50.0 100.0 Know poisoning prevention advice 66.7 100.0 Know to guide how to use, reserve 33.3 100.0 Be trained 0.0 100.0 Know poisoning prevention advice 25.0 100.0 Know to guide how to use, reserve 75.0 100.0 Having business registration 50.0 100.0 Know to poisoning treatment pesticide Pesticide sellers (n=4) Table 3.22 shows that: - Before the intervention, no Medical staff and pesticides seller is trained - After the intervention, 100 % pesticides seller and Medical staff know how to use, storage as well as prevention of pesticide poisoning - The number of stores selling pesticides already registering business increases by from 50 % to 100 % 12 Table 3.32 The result oftesting is comparition about active Enzym Cholinesterase (Normally 5,300-12,900U/L) Tan Linh Phuc Linh Test 2nd Index Test 1st Pre-intervention Post- intervention n=60(1) n=51(2) n=60 (1) n=51(2) n % n % n % n % 0.05 Result of Table 3.32 shows that: - At Tan Linh after years intervention activity enzyme cholinesterase average has increased The ratio of person who has actived enzym below normal standard decreased from 8.33 % to 1.96 % - At Phuc Linh the ratio of person who has active enzym below the normal standard will have tendency increasing (from 6.66 % to 11.76 %) Table 3.33 Comparing result test of pesticides in tea before and after intervention about all kind pesticides/01 sample and some kinds of pesticides average/01 sample Tan Linh Phuc Linh Kind of PrePostpesticides /01 intervention intervention sample n= 15 n=15 First test n=15 Second test n=15 Most 15 13 13 15 At least 2 6.46 5.80 6.00 6.86 P Average pesticides/01 sample >0.05