Acute pesticide poisoning among smallholder farmers and farmworkers

Acute pesticide poisoning among smallholder farmers and farmworkers

A REVIEW OF 13 STUDIES IN EECCA AND AFRICA September 2020

Executive Summary This report presents findings from a series of health monitoring projects conducted by PAN UK and its partner organisations in nine low and middle income countries over the past decade. Between them, these studies surveyed thousands of smallholder farmers and farmworkers about their use of – and exposure to – pesticides to build a clearer picture of the reality of pesticide use in rural communities and uncover the prevalence of acute pesticide poisoning.

Using a combination of surveys, desk research, group discussion and semi-structured interviews, the studies identified practices and behaviours which lead to pesticide exposure and have resulted in acute pesticide poisoning.

The studies reveal that acute pesticide poisoning is widespread and affects a high proportion of farmers, farmworkers and their families. Most studies found that over 40% of those surveyed had experienced at least one episode of acute pesticide poisoning in the previous 12 months. Some studies found far higher poisoning rates – in one case as high as 82%. What is more, a significant minority of respondents experience multiple poisoning events in a year.

The signs and symptoms of acute pesticide poisoning recorded ranged from serious symptoms such as convulsions and loss of consciousness to relatively short-lived effects such as headaches and dizziness.

There are implications for the long-term health of those exposed, as many of the substances used by the farmers have been associated with serious chronic illnesses including cancers and neurological diseases.

Some of the studies found children working directly with pesticides and instances of women being exposed during pregnancy. These groups are particularly vulnerable to the effects of pesticide poisoning.

A striking finding was that hardly any of the poisoning victims questioned had received professional medical treatment – whether because of a poor healthcare coverage, or the cost of treatment. The result is that hardly any poisoning incidents reach national medical statistics. Occupational pesticide poisoning is a hidden crisis and the scale of the problem is unknown to policy makers.

The findings challenge many of the assumptions that underpin pesticide regulation. They show clearly that protective measures that are supposed to manage risk and reduce exposure are rarely in place.

For example, personal protective equipment is hardly ever used; pesticides are repackaged into inappropriate containers and sold without warning labels, and even where labels are in place, many users cannot understand them.

The conditions and consequences uncovered by these studies clearly demonstrate that the existing approach to managing pesticides is failing on a massive scale. It is likely that hundreds of millions of smallholder farmers and their families in low and middle income countries are poisoned by pesticides every year. Placing responsibility for managing pesticide risks onto poorly trained, inadequately resourced users, with minimal regulatory oversight plainly does not work. In the absence of this assumed protection, the most effective way to protect human health and the environment is to remove highly hazardous pesticides from use and only allow safer, non-chemical approaches or those pesticides which do not require extra mitigation measures

Edited by: Keith Tyrell, Sheila Willis and Rina Guadagnini from project reports for PAN UK.

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Contents Executive summary ..............................................................................................................2 Introduction ...........................................................................................................................4 Data on acute pesticide poisoning....................................................................................5 Surveillance for acute pesticide poisoning......................................................................6 Methodology used by PAN UK............................................................................................7 Table 1. Survey questions concerning signs and symptoms of acute pesticide poisoning

CASE STUDIES ..................................................................................................................... 10 Case study 1 Benin ............................................................................................................ 11 Table 2. Pesticides used by cotton farmers, reported in group discussions in 2018

Case study 2 in six EECCA countries................................................................................ 14 Table 3. Survey partners and participants Figure 1. % APP over previous 12 months reported by adults who directly handle pesticides Table 4. Prevalence of APP in six surveys showing common signs and symptoms, days’ work lost and proportion seeking qualified medical advice Figure 2. % participating children reporting that they apply pesticides

Case study 3 Georgia......................................................................................................... 19 Case study 4 Ethiopia......................................................................................................... 21 Case study 5 Mali................................................................................................................ 23 Case study 6 Senegal......................................................................................................... 24 Case study 7 Tanzania........................................................................................................ 26 Discussion ........................................................................................................................... 28 Table 5. Summary of results of surveys of smallholder farmers who use pesticides, showing % self reporting incidents of acute pesticide poisoning over a 12 month period

References ........................................................................................................................... 31

Front cover photo: Hospital bed in West Africa. Credit StockSnap

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Introduction Pesticide poisoning is widely accepted as a major public health problem in low- and middle-income countries (LMICs) (Buckley1 et al., 2004; Thundiyil2 et al., 2008; Eddleston,3 2018; Jors4 et al., 2018), yet the true scale of the problem is unknown. In the early 1990s, a World Health Organization (WHO) study conservatively estimated that there could be 25 million cases of occupational pesticide poisoning each year, of which around 3 million were considered ‘acute, severe’. The same paper estimated that pesticide poisoning resulted in around 220 000 deaths annually, the majority being a result of self-poisoning, not accidental poisoning (Jeyaratnam5, 1990). No credible estimates have been published since then despite global pesticide use in agriculture almost doubling since 1990, reaching over 4 million tonnes of active ingredient by 2017 (FAO STAT, 2020). This figure does not include other significant pesticide uses, such as domestic use or spraying for vector control.

As concerning as they are, these estimates of acute pesticide poisoning are likely to significantly understate the scale of the problem. Studies have shown that a very high number of unintentional poisonings go unreported or misreported (London and Bailie6, 2001; Murray7 et al., 2002; Laborde8 et al., 2015). High levels of acute pesticide poisoning (APP) also signify a potentially larger problem of chronic pesticide exposure, the health impacts of which are even more difficult to quantify. Epidemiological studies examining occupational pesticide exposure have found associations between pesticide exposure and multiple serious chronic illnesses ranging from cancers, to neurological illnesses such as Parkinson’s disease, to reproductive and developmental disorders (e.g. Ntzani9 et al., 2013; Koutros10 et al., 2016; Gallo11 et al., 2018).

Some groups are particularly vulnerable to pesticide poisoning, such as women, particularly expectant and nursing mothers, and children. These groups form a relatively large proportion of agricultural workers. According to FAO, women represent 43 percent of the agricultural labour force worldwide (FAOSTAT, 2020). About 59 percent of all children in hazardous work aged 5–17 work in agriculture (ILO IPEC12, 2010). Even if children are not working on farms, many live on farms where the risk of pesticide exposure is relatively high.

In addition to accidental exposures, deliberate self-harm is a very significant problem. One in five global suicides are estimated to be due to intentional self-poisoning with pesticides (WHO13, 2004). Pesticide suicides primarily occur in rural areas of LMIC countries in Africa, Central America, South-East Asia and the Western Pacific. Such incidents can be significantly reduced by removing the most acutely hazardous pesticides from sale. As an example, by removing just seven HHPs from use, Sri Lanka is estimated to have prevented 93,000 deaths from suicide (Manuweera14 et al., 2008) without a negative impact on agricultural productivity (Manuweera15 et al., 2008).

The high level of poisoning places a heavy financial burden on LMICs. A study by UNEP estimated that the health costs of pesticide poisoning – defined as lost work days, outpatient medical treatment and inpatient hospitalization – in smallholder farming in 37 sub-Saharan countries amounted to US$4.4 billion in 2005 (UNEP16, 2013). Furthermore, regular episodes of mild- or medium-level health effects place an economic burden on farming households in terms of lost work, treatment and travel costs and possible reductions in productive capacity (Sherwood17 et al., 2005; Williamson18, 2011).

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Data on acute pesticide poisoning Estimates of pesticide poisonings tend to draw on official data collected by medical professionals, usually in a hospital setting. However, only a small portion of the most serious cases are seen by medical professionals and as a result, the vast majority of adverse health incidents go unrecorded. What is more, in many LMICs, reviews of hospital data are ad hoc and many hospitalized cases are missing from national data (London and Bailie6, 2001).

The situation is particularly poor in Africa. A WHO survey in 2003–04 showed that while centralized collection systems for pesticide poisoning data are common in the Americas and Europe (93% and 100%, respectively), none of the nine African countries that responded to the survey had such a system in place (WHO13, 2004).

Just 46% of WHO member countries have poison centres and the majority of these are in the Americas and Europe – Africa has just 12 poison centres (WHO Global Health Observation Data, 2018). Even where systems do exist, the range of data collected is often limited and of little value to policy-makers. In Tanzania, for example, the national health information management system only has one category for all cases of poisoning and important details on the type of pesticide, conditions of exposure and severity are not systematically collected (Lekei et al., 201419). The same DHIS2 health information management system used in Tanzania is used by 67 LMIC countries (District Health Information Software20), which suggests that they may all be lacking national data concerning pesticide poisoning.

The lack of accurate and comprehensive data on pesticide poisoning not only hides the scale of the problem, but also hinders the development of appropriate policy measures to deal with it. If policymakers do not recognize poisoning as a significant health threat, they are unlikely to allocate adequate resources or political will to tackle it (Murray7 et al., 2002; Williamson18, 2011). Similarly, if they do not have information on which pesticides are involved in poisoning, or which practices lead to hazardous levels of exposure, they will be unable to target interventions effectively.

In the absence of accurate information on the conditions under which poisoning occurs, a common response is to blame farmers, farm-workers and other end users for ‘misusing’ pesticides. This response shifts responsibility away from policy-makers and the pesticide industry on to end users and is unlikely to be effective – especially in situations where users have little-or-no access to the relevant health and safety information and are not in a position to adopt the required risk reduction behaviours (Rother21, 2018).

Very often there is a lack of information about safer alternatives, including non-chemical alternatives, which may be safer, cheaper and effective.

Photo: Pesticides in Georgia illegally repacked into plastic bags with no labels, dosage or safety instructions. Credit: PAN UK

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Surveillance for acute pesticide poisoning Field surveys have emerged as valuable tools to complement clinical-based surveillance systems. Such surveys collect data directly from exposed communities and focus on acute pesticide poisoning. They invariably reveal a high level of poisoning in the communities studied (Kishi22, 2005; Murphy et al., 200223; Mancini24 et al., 2005; Dasgupta25 et al., 2007; PAN International26, 2010).

A range of approaches for field surveillance exist: from the use of questionnaires, to open semi-structured group discussions (FAO/WHO27, 2009; FAO28, 2017). These can be complemented by biological testing, such as measuring acetylcholinesterase levels in the blood of exposed individuals (Cotton29 et al., 2015) or the use of passive sampling techniques to identify the specific pesticides to which subjects have been exposed (Anderson30 et al., 2014; Donald31 et al., 2016).

Community Pesticide Action Monitoring (CPAM) is a health monitoring tool developed by Pesticide Action Network Asia Pacific in the 1990s. It employs Participatory Action Research techniques and questionnaires to build up a picture of the local conditions under which pesticides have been used over the previous two years. It identifies routes of exposure, practices and behaviours that lead to exposure; social groups that are most at risk; the classes of pesticides, or even specific pesticides, that cause the most poisonings and the related health impacts. A series of CPAM surveys conducted between 2006 and 2009 in 21 areas in 13 African, Latin American and Asian countries estimated occupational poisoning rates of 47–59% (PAN International, 201026).

CPAM, in common with most other questionnaire approaches, concentrates on signs and symptoms of acute pesticide poisoning which appear within 12–24 hours of exposure. Mild symptoms include headache, fatigue, dizziness, nausea, while more severe symptoms can include seizures, unconsciousness, incontinence and in extreme cases, death (Thundiyil2 et al., 2008). While many of the signs and symptoms can have other causes (Litchfield32, 2005), the method depends on a ‘weight of evidence’ approach whereby multiple end users are consistently reporting similar acute effects within 24h of exposure to the same product and the evidence is consistent with other sources of information on the product, including toxicity data (FAO/WHO33, 2009).

Photo: Collecting data in Armenia. Credit PAN UK

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Methodology used by PAN UK For nearly two decades, PAN UK has conducted health monitoring surveys using a combination of surveys, desk studies, consultations, group discussion and semi-structured interviews to better understand the issue and triangulate information from different sources.

Retrospective, self-reported injury histories collected using survey questionnaires are at the heart of the approach. The questionnaires have been developed by PAN UK and adapted for use in several countries in order to identify common exposure scenarios and estimate the frequency and severity of signs and symptoms of acute pesticide poisoning. The methodology is more or less standardised, but variations can be introduced to account for specific local conditions and/or explore specific issues in more detail.

In remote, rural communities retrospective, self-reported injury histories are often the only practical source of information available on incidents of pesticide poisoning. However, retrospective studies are subject to recall bias and so we considered the likely accuracy and direction of bias of the results.

Retrospective, self-reported injury histories are commonly used for reporting sports injuries over a 12 month sporting season. A study of the accuracy of the method (Gabbe34 et al., 2003) showed that participants were able to recall the number of injuries and the body region affected with a high degree of accuracy over a 12 month recall period. They were less accurate in their recall of detailed diagnoses beyond a 2 month period but their ability to recall these details was improved when a clear definition of the injury was reported. The recall bias over 12 months tended to lead to under-reporting of incidents, and would therefore lead to a conservative estimate of the scale of injury. A study by Jenkins35 et al., 2002, considered three studies of time-dependent memory recall and found a more significant drop in reported incidents beyond a two month period. Their conclusion was that recall periods of greater than 2 months are likely to significantly underestimate injury rates.

A study of the effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey in the United States (Warner36 et al., 2005) also found a significant drop in the number of reported incidents over time and pointed out that survey approaches with longer recall reference periods must accept the trade-off of loss of episodes as a result of forgotten events versus increased sample sizes due to the longer periods. The PAN UK team took the view that the trade-off was worthwhile in this case because: 66 Recall bias tends to give a conservative result 66 The seasonality of pesticide use means that collecting reports of APP over a 12 month period gives more comparable results (similar rationale to the sports injury surveys over a 12 month sporting season described above) For the purposes of the surveys, acute pesticide poisoning is defined as any symptom or health effect resulting from exposure to a pesticide within 24 hours of pesticide use. Existing tools and common signs and symptoms of acute pesticide poisoning were used as a starting point (CPAM37, Murphy et al., 200238, Thundiyil2 et al., 2008, Persson et al., 199839). Signs and symptoms that can only be determined in a clinical setting were eliminated and descriptions were adapted into simpler language that could be understood by non-clinicians. The final list is provided in Table 1.

The interviewees are also asked about the frequency of incidents over the previous 12 months in order to capture information on the cumulative frequency of such episodes.

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TABLE 1. SURVEY QUESTIONS CONCERNING SIGNS AND SYMPTOMS OF ACUTE PESTICIDE POISONING After exposure to pesticides do you notice any unusual signs or symptoms?

IF NO: PLEASE GO TO QUESTION 2.28

(i.e. signs and symptoms that you do not usually suffer from)

Eye irritation

IF YES: please tick all that apply Fever Headache Convulsion Dizziness Shortness of breath Unusual heart rhythm Memory loss Tremor Blurred vision Excessive sweating Insomnia Weakness Cough Skin irritation Nausea Vomiting Diarrhoea Other (please describe)

How soon after the pesticide exposure do you experience signs/ symptoms? (hours)

Responses that are longer than 24 hours are not included in the estimated APP%

How often has this type of incident occurred in the last 12 months?

All participants are farmers or farm workers in the target area. Selection criteria vary somewhat, depending on the purpose of the survey (details provided in case studies below).

In each country the questionnaire is translated into the most appropriate language. A local survey team is trained and observed conducting the survey, after which any problems or queries are discussed. The teams are alerted to issues of confidentiality and ethical standards, including making clear the purpose of the data and how it may be used to participants and survey teams are provided with a short script to use when introducing the survey. To the extent possible, surveys are conducted without bystanders present and at a location and time that are convenient for the participant. It is particularly important to ensure that farm workers are able to answer openly without concerns that they will be penalised by their employer for participating.

The survey is tested on a small scale during training to ensure that the meaning of questions is clear and that the questions are relevant in the context. It is then refined before rolling out to the target population.

The survey data can be disaggregated in a variety of ways, including by age, gender, farm size, farm worker or farm owner and, where appropriate, language(s) spoken. Strong efforts are made to validate information concerning any product(s) being reported in relation to poisoning incidents, including checking the product label where available and checking details of available products with local retailers.

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Ideally, batches of approximately 20 completed questionnaires are shared with the PAN UK team as the field work progresses, so that errors can be found and explained to the field team as the data collection continues.

The surveys were completed on paper or on excel spreadsheets on laptops, depending on the context.

For future studies, PAN UK is currently trialling an app-based system.

Photo: Handling pesticides without protection in Ethiopia - credit PAN Ethiopia

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CASE STUDIES Between 2010 and 2019, PAN UK and its partners conducted health monitoring surveys in ten countries and questioned over 2,000 respondents.

While these surveys have followed the basic approach outlined above, they have each been adapted to reflect local conditions, and/or to collect additional data on specific parameters – for example, examining how factors such as age, gender or ethnic group affect exposure patterns, or identifying practices that can lead to higher incidences of poisoning.

Photo: Fleurianne, pictured aged 9, lost 4 years of schooling after she was poisoned by pesticides in Benin. Fleurianne’s mother is pictured holding the container of the product that caused the incident. Credit PAN UK / Obepab

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Case study 1 Benin In 2016 and 2018 PAN UK and Organisation Béninoise pour la Promotion de l’Agriculture Biologique (OBEPAB) undertook surveys of cotton farmers and a series of consultations with farmers, clinicians and epidemiologists. The purpose was to understand the scale of the problem of pesticide poisoning among cotton farmers and to determine how much information on incidents of pesticide poisoning reaches national authorities and decision makers.

The questionnaire was developed in close collaboration between PAN UK and OBEPAB and in consultation with four cotton farmers from Glazoué area (who helped to refine the questions). In addition to the questionnaire, the team used group discussions and semi-structured interviews with a variety of stakeholders in order to elicit more information and verify survey results.

Country: Benin Partner Organisation: OBEPAB Years conducted: 2016 and 2018 Number of participants: 493 (2016) and 507 (2018) Description of participants: 66 Aged over 18 66 Smallholder farmers growing cotton 66 Working on their own family’s land (not paid farm workers) 66 41% selected farmers were organic and the remainder were conventional cotton farmers in both surveys 66 36% participants were women in both surveys Location: Two locations in the North of Benin (Kandi and Sinende) and two further South (Glazoué and Djidja).

Protective equipment During a group discussion, cotton farmers reported that they usually have training on the use of pesticides and protective equipment, but the protective equipment is not provided and farmers struggle to find Personal Protective Equipment (PPE) in local shops or other outlets.

Results for conventional farmers only 66 % pesticide users reporting acute pesticide poisoning (APP) in previous 12 months: 42% in 2016 and 51% in 2018.

66 % farmers missing days’ work due to APP: 21% in 2016 and 9% in 2018.

66 Number of incidents in previous 12 months: In 2016, 32% of farmers experienced multiple APP. 17% farmers reported six or more incidents in the previous 12 months.

In 2018, 20% conventional farmers reported suffering six or more incidents in the previous 12 months.

66 Signs and symptoms reported by farmers reporting APP: The types of symptoms experienced by farmers included localised reactions such as eye irritation/inflammation (93% of farmers suffering symptoms) and skin (91%) irritation. A high proportion of farmers

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also experienced systemic reactions such as blurred vision (51%), general weakness (46%), tremors (34%), insomnia (34%), vomiting (9%), memory loss (3%) and convulsions (2%).

Doctors and farmers consulted in interviews and group discussions (not the survey) also reported severe rashes and skin lesions and sexual dysfunction, which they associated with pesticide exposure.

The rashes and lesions commonly seemed to be associated with leaking backpack sprayers resulting in heavy exposure of skin on the back and groin.

66 % seeking medical attention: in the 2016 survey 13% of affected farmers said they went to medical facilities for treatment by qualified practitioners, while 48% bought medication from an unqualified person.

Photo: Cotton farmer, Aziadougan Tadogbe Calixte, reports a deformity of his little finger that occurred after repeated exposure to a pesticide he uses in cotton farming. Credit PAN UK

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Pesticides reported by farmers in 2018 Group discussions with conventional cotton farmers in 2018 were used to identify common pesticides in use. The trade names were investigated afterwards to determine the active ingredients and other attributes.

TABLE 2. PESTICIDES USED BY COTTON FARMERS, REPORTED IN GROUP DISCUSSIONS IN 2018 PESTICIDE (ACTIVE INGREDIENT)

PESTICIDE FAMILY

Chlorpyrifos

organophosphate

Cypermethrin

pyrethroid

Emamectin benzoate

emamectin

Endosulfan

organochlorine

Glyphosate

Phosphanoglycine (OP)

Lambda-cyhalothrin

pyrethroid

Profenofos

organophosphate

Acetamiprid

neonicotinoid

Fluometuron

Phenylurea herbicide

Prometrine

Triazine herbicide

Post-registration monitoring (information from results of surveys and consultations) Doctors and farmers told us that most incidents of pesticide poisoning are not reported to medical services. When people suffering from acute pesticide poisoning do seek medical attention, the health facilities are not equipped to analyse human samples and it is usually impossible to determine which pesticide has caused the problem. Incidents may be recorded in hand-written hospital case notes but there is no way of collating these incidents for monitoring purposes. Generally, the incidents that are reported to a higher level within the health service are limited to incidents of mass poisoning by ingestion. This sometimes occurs in families where bottles of pesticides are mistaken for cooking oil and there have been similar incidents in restaurants too. Fatalities due to pesticide poisoning do occur, but there is no system of collating information of this type.

Consultations revealed a lack of awareness among higher level decision makers of the serious health impacts being suffered by cotton growing communities in Benin. A lack of monitoring systems likely contributes to this.

Conclusion, Benin studies The results of all the studies and consultations indicate that conventional cotton farmers in Benin are frequently exposed to HHPs under poor conditions of use. They are using HHPs without protective equipment and a high proportion of farmers are suffering signs and symptoms of pesticide poisoning.

Many farmers suffering multiple incidents every year. The impacts of acute pesticide poisoning can be severe. The scale of the problem also suggests a large and unquantified problem of chronic exposure.

The majority of such incidents are invisible to health services and decision makers, although there is a high level of concern among medical practitioners with direct experience in the cotton-growing areas.

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Case study 2 in six EECCA countries A study in six countries in the Eastern Europe, Caucasus and Central Asia (EECCA) region gathered information about pest handling and application practices and self-reported signs and symptoms of acute pesticide poisoning. Using questionnaires, discussions and desk research, the team began to build a picture of how pesticides are used, common exposure routes and some of the ways people experience the impact on their health. Unusually, the study addressed several potentially vulnerable groups, including men, women and children living on small farms as well as seasonal agricultural workers.

Small family farms are an important feature of agriculture in the region and it is common for the whole family to be involved in farm work and, potentially, to come into contact with pesticides.

In addition to the adult surveys, a children’s survey was developed. It was shorter, with simpler language and pictures.

The surveys were supplemented with desk research, focus group discussions and semi-structured interviews were conducted with a wide range of stakeholders including local and national authorities, research institutions, retailers and farmers’ groups.

Country: six countries in Eastern Europe, Caucasus and Central Asia (EECCA) – Armenia, Belarus, Georgia, Kyrgyzstan, Moldova and Ukraine Year: 2015 Number of participants in surveys: approximately 200 per country, total 1,187 Description of participants in the survey: 66 People living or working on farms in target locations 66 Farms where pesticides are used

TABLE 3. SURVEY PARTNERS AND PARTICIPANTS COUNTRY PARTNER ORGANISATION

LOCATION OF SURVEY

MEN WOMEN TOTAL ADULTS

Armenia

Armenian Women for Health and Healthy Environment (AWHHE)

Marzes of 3 Armavir, Ararat, Tavush and Gegharkunik

157

160

18

16

Belarus

Green Cross Belarus

Bragin, Gomel Region

75

121

47

32

Georgia

Agroservice

Marneuli District 77

123

200

0

0

Kyrgyzstan Biom

Osh

101

68

169

19

12

Moldova

Agentia Pro Dezvoltare Rurala (APDR)

Hincesti disctrict

57

22

79

50

71

Ukraine

All-Ukrainian Environmental League

Vinnitsya region 78

85

163

15

15

46

BOYS GIRLS <18 YRS <18 YRS

Note: These surveys were done on a pilot scale and were intended to explore different vulnerabilities to pesticide exposure and poisoning. Some countries focused particularly on men, women or children and these groups were more highly represented in their samples. Comparisons between countries are tentative and require further exploration.

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League

ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Note: These surveys were done on a pilot scale and were intended to explore different vulnerabilities to pesticide exposure and poisoning. Some countries focused particularly on men, women or children and these groups were more highly represented in their samples. Comparisons between countries are tentative and require further exploration.

Prevalence of APP among adults who handle pesticides

The tableofand graph indicate high degree variation in the prevalence of self-reported APP across Prevalence APP among adultsa who handle of pesticides

the region. Caution is needed when interpreting these comparisons, however. Sample sizes were small

Theand table andfactors graphwere indicate high degree variation in the prevalence of self-reported APP across other not a the same in theofdifferent surveys.

In Armenia, for example, the focus was on thewomen re gion.working Cautioninisthe needed when interpreting these comparisons, sizes horticultural sector supplying Yerevan, which ishowever. known forSample relatively highwere pesticide use, whilst neighbouring Georgia the target was dominated mixednia, family small and otheinr factors we re not the same in thearea diffe re nt surve ys. by In Arme forfarms. e xample , the focus was on women working in the horticultural sector supplying Yerevan, which is known for relatively high pesticide use, whilst in neighbouring Georgia the target area was dominated by mixed FIGURE 1. % ACUTE PESTICIDE POISONING OVER PREVIOUS 12 MONTHS REPORTED family farms.

BY ADULTS WHO DIRECTLY HANDLE PESTICIDES

Figure 1. % APP over previous 12 months reported by adults who directly handle pesticides 90%

n=49

80% 70% 60% 50% 40%

n=161

n=124 n=25

30% 20%

n=117

10% 0%

Armenia

Belarus

Georgia

% reporting < six incidents in 12 months

n=73 Kyrgyzstan

Moldova

Ukraine

% reporting at least six incidents in 12 months

% users of pesticides wearing usual, non-protective % users of pesticides wearing usual, non-protectiveclothes clotheswhen whenhandling handlingpesticides pesticides Many of these respondents said the y wore gloves, boots and/or masks,but they did not wear Many of these respondents said they wore gloves, boots and/or masks, but they did not wear protective protective coveralls during handling/use of pesticides or change out of these contaminated clothes coveralls during handling/use of pesticides or change out of these contaminated clothes immediately immediately afterwards. On inve stigation, many of the masks and glove s re porte d we re not afterwards. On investigation, many of the masks and gloves reported were not protective from chemicals protective from chemicals (they were often supplied by buildersâ&#x20AC;&#x2122; merchants for manual tasks rathe r (they were often supplied by buildersâ&#x20AC;&#x2122; merchants for manual tasks rather than chemical protection), so it was difficult to ascertain the level of protection afforded by these items during the survey.

Photo: Arsenical pesticide illegally packaged and sold in a glass bottle in Armenia. Credit PAN UK

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Signs and symptoms reported by farmers reporting APP

TABLE 4. PREVALENCE OF APP IN SIX SURVEYS SHOWING COMMON SIGNS AND SYMPTOMS, DAYS’ WORK LOST AND PROPORTION SEEKING QUALIFIED MEDICAL ADVICE COUNTRY SIGNS AND SYMPTOMS REPORTED

% SUFFERING APP

MEAN NUMBER OF DAYS’ WORK LOST PER 12M

BY GROUP AFFECTED BY APP

% OF GROUP AFFECTED BY APP SEEKING QUALIFIED MEDICAL ADVICE

Armenia

Most common; nausea, dizziness, headache Less common; cough, shortness of breath, skin irritation, unusual heart rhythm, blurred vision Convulsions; not reported

44%

Just one person reported to have lost 1 working day

5% (2/40)

Belarus

Most common; nausea, dizziness, headache, eye irritation Less common; Fever, shortness of breath, excessive sweating, cough, skin irritation, vomiting Convulsions; reported by 1 person

82%

5 people (13%)

19% (3/16)

Georgia

Max 3 days Mean = 1.7

Most common; dizziness, headache, 14% skin irritation, eye irritation Less common; weakness, insomnia, unusual heart rhythm, cough, excessive sweating, unusual heart rhythm Convulsions; reported by 1 person

Kyrgyzstan Most common; eye irritation, 56% headache, dizziness, weakness, nausea Less common; skin irritation, coughing, fever, vomiting, shortness of breath Convulsions reported by 2 people (3%)

16

Just one person reported taking time off work (2 months)

15% (2/13)

9 people (13%)

4% (3/70)

Max. 3 days Mean = 1.3 days

Moldova

Most common; Skin and eye irritation, headache, shortness of breath, excessive sweating, skin irritation Less common; weakness, blurred vision, weakness, fever Convulsions; reported by 1 person

10%

0

14% (1/7)

Ukraine

Most common; eye irritation, headache, weakness, cough, skin irritation, nausea Less common; fever, unusual heart rhythm, tremor, excessive sweating, insomnia, vomiting, diarrhoea Convulsions; not reported

59%

Just one person reported to have lost 2 working days

13% (12/95)

ŽŶǀƵůƐŝŽŶƐ͖ ŶŽƚ ƌĞƉŽƌƚĞĚ ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

ŶLJ ŝŶĨŽƌŵĂƚŝŽŶ ĂďŽƵƚ ƚŚĞ ƉĞƐƚŝĐŝĚĞƐ ƚŚĂƚ ǁĞƌĞ ŝŶǀŽůǀĞĚ ŝŶ WW͍ Children’s surveys ƐĞĐŽŶĚ ƋƵĞƐƚŝŽŶŶĂŝƌĞ ǁĂƐ ƵƐĞĚ ƚŽ ĐŽůůĞĐƚ ĚĂƚĂ ĨƌŽŵ ĐŚŝůĚƌĞŶ ůŝǀŝŶŐ ŽŶ ĨĂƌŵƐ ŝŶ ƚŚĞ ƚĂƌŐĞƚ ĂƌĞĂ͘ dŚĞ ƐƵƌǀĞLJ ĨŽƌ ĐŚŝůĚƌĞŶ ŝƐ ƐŚŽƌƚ ĂŶĚ ƵƐĞƐ ƐŝŵƉůĞ ƋƵĞƐƚŝŽŶƐ ĂŶĚ ƉŝĐƚƵƌĞƐ ;&ŝŐ͘ϭͿ͘ Children’s surveys

A second questionnaire was used to collect data from children living on farms in the target area. The dŚĞ ĚĂƚĂ ĐŽůůĞĐƚĞĚ ŝŶ <LJƌŐLJnjƐƚĂŶ ĂŶĚ DŽůĚŽǀĂ ƐŚŽǁĞĚ ĂŶ ƵŶĞdžƉĞĐƚĞĚůLJ ŚŝŐŚ ƉƌŽƉŽƌƚŝŽŶ ŽĨ survey for children is short and uses simple questions and pictures (Fig.2). ƉĂƌƚŝĐŝƉĂƚŝŶŐ ĐŚŝůĚƌĞŶ ĚŝƌĞĐƚůLJ ŝŶǀŽůǀĞĚ ŝŶ ƵƐŝŶŐ ƉĞƐƚŝĐŝĚĞƐ ;Ϯϲй ĂŶĚ ϯϵй ƌĞƐƉĞĐƚŝǀĞůLJͿ ĂƐ ǁĞůů ĂƐ The data collected in Kyrgyzstan and Moldova showed an unexpectedly high proportion of participating ƵŶĚĞƌƚĂŬŝŶŐ ŽƚŚĞƌ ƚĂƐŬƐ ƚŚĂƚ ŵĂLJ ĞdžƉŽƐĞ ƚŚĞŵ ƚŽ ƚŚĞƐĞ ŚĂnjĂƌĚŽƵƐ ĐŚĞŵŝĐĂůƐ͘ children directly involved in using pesticides (26% and 39% respectively) as well as undertaking other tasks that may expose them to these hazardous chemicals.

&ŝŐƵƌĞ Ϯ͘ й ƉĂƌƚŝĐŝƉĂƚŝŶŐ ĐŚŝůĚƌĞŶ ƌĞƉŽƌƚŝŶŐ ƚŚĂƚ ƚŚĞLJ ĂƉƉůLJ ƉĞƐƚŝĐŝĚĞƐ

FIGURE 2. % PARTICIPATING CHILDREN REPORTING THAT THEY APPLY PESTICIDES

Total number of children participating

Armenia

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tŽŵĞŶ ĂŶĚ 79 ĐŚŝůĚƌĞŶ ĞdžƉŽƐĞĚ Kyrgyzstan 31 Moldova 121 ƚŽ ƉĞƐƚŝĐŝĚĞƐ Ukraine 30 dŚĞ ĨŝŶĚŝŶŐƐ ŝŶĚŝĐĂƚĞ ƚŚĂƚ women’s roles ĂŶĚ ƉŽƚĞŶƚŝĂů ĞdžƉŽƐƵƌĞ ƚŽ ƉĞƐƚŝĐŝĚĞƐ ǀĂƌLJ ƐŝŐŶŝĨŝĐĂŶƚůLJ͘ :ƵƐƚ ϰй ŽĨ ƚŚĞ ǁŽŵĞŶ ŝŶ ƚŚĞ ƐƚƵĚLJ ŝŶ ĞůĂƌƵƐ ƐĂŝĚ ƚŚĞLJ ŚĂŶĚůĞĚ ƉĞƐƚŝĐŝĚĞƐ ĚŝƌĞĐƚůLJ͕ Women and children exposed to pesticides ǁŚŝůĞ ƚŚĞ ĨŝŐƵƌĞ ǁĂƐ ϱϲй ŝŶ <LJƌŐLJnjƐƚĂŶ ĂŶĚ ŚŝŐŚĞƌ Ɛƚŝůů ŝŶ DŽůĚŽǀĂ ĂŶĚ hŬƌĂŝŶĞ͘ /ƚ ŝƐ ŽĨƚĞŶ ĂƐƐƵŵĞĚ ƚŚĂƚ ŵĞŶ ĂƌĞ Ăƚ ŐƌĞĂƚĞƐƚ ƌŝƐŬ ŽĨ ƉĞƐƚŝĐŝĚĞ ƉŽŝƐŽŶŝŶŐ ďĞĐĂƵƐĞ ƚŚĞLJ ĨƌĞƋƵĞŶƚůLJ ƚĂŬĞ ŽŶ ƚŚĞ ƚĂƐŬ ŽĨ The findings indicate that women’s roles and potential exposure to pesticides vary significantly. Just 4% of the women in the study in Belarus said they handled pesticides directly, while the figure was 56% in ƐƉƌĂLJŝŶŐ ƉĞƐƚŝĐŝĚĞƐ͘ ,ŽǁĞǀĞƌ͕ ƚŚĞ ƐƚƵĚŝĞƐ ŽĨ ĨĂƌŵŝŶŐ ĨĂŵŝůŝĞƐ ƐŚŽǁĞĚ ƚŚĂƚ͕ ǁŚŝůĞ ŵĞŶ ĂƌĞ ŽĨƚĞŶ Ăƚ Kyrgyzstan and higher still in Moldova and Ukraine. It is often assumed that men are at greatest risk of ŚŝŐŚ ƌŝƐŬ͕ ŵĂŶLJ ǁŽŵĞŶ ĂŶĚ ĐŚŝůĚƌĞŶ ĂƌĞ ĂůƐŽ ƚĂŬŝŶŐ ŽŶ ƚŚŝƐ ŚĂnjĂƌĚŽƵƐ ǁŽƌŬ͕ ĚĞƐƉŝƚĞ ƚŚĞŝƌ pesticide poisoning because they frequently take on the task of spraying pesticides. However, the studies ƉŚLJƐŝŽůŽŐŝĐĂů ǀƵůŶĞƌĂďŝůŝƚLJ ƚŽ ƚŚĞ ŝŵƉĂĐƚƐ ŽĨ ƉĞƐƚŝĐŝĚĞƐ ŽŶ ƚŚĞŝƌ ŚĞĂůƚŚ͘ Belarus

of farming families showed that, while men are often at high risk, many women and children are also

taking on this hazardous work, despite their physiological vulnerability to the impacts of pesticides on WŽƐƚͲƌĞŐŝƐƚƌĂƚŝŽŶ ŵŽŶŝƚŽƌŝŶŐ ;ŝŶĨŽƌŵĂƚŝŽŶ ĨƌŽŵ ƌĞƐƵůƚƐ ŽĨ ƐƵƌǀĞLJƐ ĂŶĚ ĐŽŶƐƵůƚĂƚŝŽŶƐͿ their health.

KǀĞƌ Ăůů Ɛŝdž ĐŽƵŶƚƌŝĞƐ͕ Ă ůĂƌŐĞ ŶƵŵďĞƌ ŽĨ ĂĚƵůƚƐ ;ϯϴй͕ ϮϬϴͬϱϰϵͿ ƉĂƌƚŝĐŝƉĂƚŝŶŐ ŝŶ ƚŚĞ ƐƵƌǀĞLJƐ ǁŚŽ ŚĂŶĚůĞ ƉĞƐƚŝĐŝĚĞƐ ƌĞƉŽƌƚĞĚ ƐƵĨĨĞƌŝŶŐ ƐŝŐŶƐ ĂŶĚ ƐLJŵƉƚŽŵƐ ŽĨ ƉĞƐƚŝĐŝĚĞ ƉŽŝƐŽŶŝŶŐ ŝŶ ƚŚĞ ƉƌĞǀŝŽƵƐ ϭϮ ŵŽŶƚŚƐ͘ sĞƌLJ ĨĞǁ ŝŶĐŝĚĞŶƚƐ ǁĞƌĞ ƌĞƉŽƌƚĞĚ ƚŽ ŚĞĂůƚŚ ƐĞƌǀŝĐĞƐ Žƌ ŽƚŚĞƌ ĂƵƚŚŽƌŝƚŝĞƐ͘ sĞƌLJ ĐŽŵŵŽŶůLJ͕ Post-registration monitoring (information from results of surveys and consultations) ƉĂƌƚŝĐŝƉĂŶƚƐ ƌĞƉŽƌƚĞĚ ƚŚĂƚ ƚŚĞLJ ƐĞůĨͲƚƌĞĂƚĞĚ ďLJ ĚƌŝŶŬŝŶŐ LJŽŐŚƵƌƚ͕ ĂŶĚ ƐŽŵĞƚŝŵĞƐ ĂĐƚŝǀĂƚĞĚ ĐŚĂƌĐŽĂů͕ Over all six countries, a large number of adults (38%, 208/549) participating in the surveys who handle ĂŶĚͬŽƌ ďĞĚ ƌĞƐƚ͖ Žƌ ƐŝŵƉůLJ ďLJ ǁĂŝƚŝŶŐ ĨŽƌ ƐLJŵƉƚŽŵƐ ƚŽ ĐůĞĂƌ ƵƉ͘ ǀĞŶ ƐĞǀĞƌĞ ƐLJŵƉƚŽŵƐ ǁĞƌĞ pesticides reported suffering signs and symptoms of pesticide poisoning in the previous 12 months. ĐŽŵŵŽŶůLJ ƚƌĞĂƚĞĚ ŝŶ ƚŚŝƐ ǁĂLJ ǁŝƚŚŽƵƚ ĂŶLJ ŵĞĚŝĐĂů ĂƐƐŝƐƚĂŶĐĞ͘ Very few incidents were reported to health services or other authorities. Very commonly, participants reported that they self-treated by drinking yoghurt, and sometimes activated charcoal, and/or bed rest; or simply by waiting for symptoms to clear up. Even severe symptoms were commonly treated in this way without any medical assistance.

Consultations and desk studies revealed that several participating countries have conducted ad hoc studies on DDT in breastmilk or sampling of soils or crops for pesticide residues but regular monitoring/ surveillance systems are lacking. All of the participating countries reported that they lack systems for the routine collection of data on pesticide poisoning. Without such information, they explained, it is difficult for them to take robust regulatory action on hazardous pesticides.

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Photo: Ready to spray pesticides in Georgia. No protective equipment is used by this farmer Credit PAN UK

Conclusion, EECCA study The studies in six EECCA countries revealed new information concerning a hidden problem of acute pesticide poisoning. None of the participating countries has a system in place to collect data on pesticide poisoning and the vast majority of poisoning incidents, it seems, are not reported to health services or other authorities.

The studies of people living and/or working on farms that use pesticides indicate that pesticide poisoning is common (almost 40%). Living and working on small farms puts people at risk of exposure to pesticides even if they are not handling them directly. 12% respondents who said they donâ&#x20AC;&#x2122;t handle pesticides also reported that they had experienced acute pesticide poisoning in the previous 12 months (this figure includes the children that participated in surveys). Acute pesticide poisoning is bad enough in itself, but may also indicate a larger problem of chronic pesticide exposure and long-term impacts on health.

The studies challenge prevailing assumptions regarding the role of children in relation to pesticides. The teams in Kyrgyzstan and Moldova were surprised to find more than a quarter of participating children directly involved in using pesticides (26% and 39% respectively) as well as undertaking other tasks around the farm that may expose them to these hazardous chemicals, such as picking fruit and washing spray equipment.

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Case study 3 Georgia Country: Georgia Partner organisation: EcoLife Year conducted: 2016 Number of participants: 920 (448 men, 472 women) Location: Kvemo Kartli Description of participants: Participants were adult farmers and farm workers from the target area. Respondents were selected to give a reasonable representation of men, women, farmers, farm workers and people for whom Georgian is not their first language so that adequate comparisons could be made between the different groups in terms of risk of pesticide exposure and poisoning.

Protective equipment: Just 2 respondents (0.2%) reported wearing protective coveralls when using pesticides. The vast majority simply reported wearing ordinary non-protective clothes. In addition, 37% farm workers reported wearing boots and 27% gloves. However, it was difficult to determine how protective these items were.

They were often sourced at buildersâ&#x20AC;&#x2122; merchants and not necessarily designed to protect from chemicals.

Just 3% farmers and 4% farm workers reported having had any training in the last decade on the use of protective equipment when handling pesticides. This may be an important factor in the extremely low use of PPE. In addition, summer temperatures are high in Georgia, making wearing masks and overalls hot and uncomfortable.

Photo: A picture of face masks on sale in Georgia in 2016 where protective equipment was rarely found on sale with pesticides and, when it was, it was usually not of a type that would provide suitable protection. Credit: PAN UK

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% pesticide users reporting APP in previous 12 months: 20% of people who handle pesticides in the survey said they suffered from signs and symptoms of APP in the previous 12 months.

Number of incidents in previous 12 months: There was a gender difference here. None of the participating women reported more than one incidence of APP over the previous 12 months. However, 6% (46/920) of men using pesticides suffered multiple incidents over a 12-month period. % seeking medical attention: 12% of people who reported APP said they sought medical attention.

Post-registration monitoring (information from consultations with national authorities) Georgia lacks a reporting mechanism for pesticide poisoning incidents.

Products linked to APP The participants in the survey were asked which pesticide they had been using when they experienced unusual signs and symptoms. Unfortunately, because of the very common practice of repacking pesticides into unlabelled containers, and other issues with linking the product to the incident, only a small proportion of the incidents of APP could be linked to specific products. In these instances, the most cited pesticides were lambda cyhalothrin, metribuzin and dimethoate.

Conclusion Georgia study This was an unusually large-scale study that revealed poor conditions40 of use of pesticides. The use of PPE was very low and repacking of pesticides into unlabelled bags and bottles was common, meaning that essential safety and use information was often absent and the risk of accidental exposure increased.

The study was conducted in close collaboration with Georgian national authorities. Following the study, national authorities conducted measures to tackle the practice of pesticides retailers repacking pesticides into unsuitable containers. They also used the survey data to submit two reports to the Rotterdam Convention under Article 6 on Severely Hazardous Pesticide Formulations, one concerning dimethoate and the other concerning lambda cyhalothrin.

Photo: Surveying farmers in Georgia Credit PAN UK

20

ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Case study 4 Ethiopia Country: Ethiopia Partner Organisation: PAN-Ethiopia Year conducted: 2018 Number of participants: Random selection of 15 smallholders from each of 5 villages, totalling 75 smallholder farmers (six women), plus a smaller sample of 15 casual workers (one woman). Assessed by formal quantitative survey via individual interviews, conducted by trained field agents.

Description of participants: For 56% of respondents, vegetable production was their only income. The other 44% grow cereals, rear livestock and practice other non-farming activities in addition to vegetable production. The size of farmland cultivated under vegetables ranged from a minimum of 0.125ha to a maximum of 8ha, with an average of 0.65ha.

Location: Five villages [Aluto, Abein Deneba, Abine Germama, Bochesa and Edo Gojola] in Adami TuluJido Kombolcha district within East Shoa Zone of Oromia Region in the Central Rift Valley. This is a major vegetable growing area, supplying much of the capital’s vegetable demand.

Protective equipment: Not assessed although the area is renowned for very poor pesticide use practices, including very little use of proper PPE. % pesticide users reporting APP in previous 12 months: 66 Farmer respondents 60 farmer respondents (i.e. 80% of the total sample population) said that they didn’t suffer any pesticide poisoning in the last 12 months (Jun 2017-Jun 2018). The remaining 15 farmers (20% of the farmers) said either they themselves or somebody from their family was poisoned.

From those farmers who reported a poisoning incident, 14 of them, who were adults, suffered the poisoning incident themselves. The remaining person reported was 15-18 years old and the reported poisoning incident happened because he/she drank the chemical. The respondent did not indicate whether this was deliberate intent of self-harm or accidental poisoning, e.g. by drinking liquid pesticide stored in a soft drinks bottle.

66 Farmer worker respondents Out of the 15 respondents, 11 of them (73%) said they have experienced at least one pesticide poisoning incident in the last 12 months. Out of these 11 casual workers who experienced poisoning, 2 of them (18%) were 15-18 years old while the other 9 were adults. % farmers missing days’ work due to APP: Not assessed.

Signs and symptoms reported: Headache, irritated skin, stinging eyes and nose, stomach upset, fainting, numbness, vomiting, blurred vision, dizziness, diarrhoea. % seeking medical attention: Not assessed.

Active ingredients in pesticides reported associated with APP: Malathion, mancozeb, profenofos, lambda-cyhalothrin, metalaxyl, spinetoram, Mitac, endosulfan, 2, 4-D, and dimethoate.

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Conclusion The range of symptoms reported above align well with typical acute pesticide poisoning symptoms from many other surveys, especially of exposure to neurotoxic active ingredients, and with PAN UKâ&#x20AC;&#x2122;s two decades of experience of documenting poisoning incidents (following recommended guidance for incident investigation from Rotterdam PIC Convention).

The data from the very small sample of farmer and farm workers interviewed suggests an alarmingly high rate of possible poisoning incidents. Reducing farm worker exposure to pesticides and the risk of ill-health effects is challenging, as they are casual, hired labourers with little power to change their practices, rarely staying on the same farm and hard to engage in training or awareness-raising.

Photo: Spraying pesticides with no protective equipment in Ethiopia - credit PAN Ethiopia

22

ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Case study 5 Mali Country: Mali Partner Organisation: PAN-Mali Year conducted: 2010-11 Number of participants: 357 Description of participants: 73% male, 27% female Location: three villages - Diakorola- Diaka, Kaboïla and Coulibalibougou – in the Sikasso region Protective equipment: Most of the participants wore long sleeves and/or trousers, and thus considered themselves to be protected. Just 6% wore internationally recognised PPE. % pesticide users reporting APP in previous 12 months: 25% of participants reported an incident of APP in the previous 12 months.

Signs and symptoms reported by farmers reporting APP: TOP THREE SYMPTOMS: Headache

83%

Excessive sweating

44%

Blurred vision

32%

% seeking medical attention: Went to hospital

8%

No treatment at all

90%

The low numbers of people seeking medical attention at the hospital demonstrates the difficulty in defining the extent of pesticide poisoning – based on this survey, hospital records will produce an underreporting rate of 92%.

Conclusion Farmers in the cotton producing regions of Mali overwhelmingly rely on pesticides for crop protection, but do not have adequate knowledge or equipment to manage the elevated risks of the products available. This survey identified almost universal poor practices. Internationally recommended PPE is virtually absent, although many users do try to use locally available alternatives.

This community monitoring project documented the high-risk use of pesticides, including endosulfan despite a ban being in force since 2008 in West Africa. A quarter of farmers surveyed had experienced an incident consistent with acute pesticide poisoning in the last year, citing headaches, blurred vision and excessive sweating, all symptoms typical of nervous system poisoning.

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Case study 6 Senegal Country: Senegal Partner Organisation: PAN-Africa Year conducted: 2010 Number of participants: 1,314 (119 female 1,195 male) The main survey focused on pesticide use practices by men – pesticide application is conducted almost entirely by men in this region. 119 women were interviewed to capture incidents of accidental or bystander exposure.

Location: Némataba, Kandiaye, Saré Coly, Sallé and Kandia, Senegal Protective equipment: Internationally recommended PPE is almost entirely absent, although many users do try to use locally available alternatives.

The poor handling practices are compounded by poor equipment, and spills of pesticide coming into contact with unprotected skin or through inhalation are common. 61% of these spills occur during spraying.

Store pesticides in the home

71%

Spraying into the wind

38%

Long sleeves or trousers as PPE

47%

Gloves (not international standard)

13%

Overalls (international standard PPE)

2%

Empty pesticide containers still contain toxic residues, and should be triple rinsed, punctured and recycled or disposed. While most countries lack a final disposal route, rinsing and puncturing should be done – however not a single farmer reported doing this.

Return containers to source

4%

Throw containers into the field

23%

Burn containers in the field

57%

Domestic reuse

10%

The re-use of ‘empty’ containers regularly causes poisoning incidents, often involving children and frequently leading to multiple deaths % of participants reporting APP in previous 12 months: Only women were questioned about APP. The survey sought to identify cases of exposure of other household members who may be exposed via take-home pathways including contaminated equipment or clothes, storage of pesticides in homes, or domestic reuse of empty containers. Even though none of the respondents were directly involved in pesticide application, some 7% of them experienced symptoms of poisoning in the previous 12 months.

Signs and symptoms reported by farmers reporting APP: the top three symptoms were headache, blurred vision and dizziness.

Pesticides reported by farmers: The products used include WHO Class Ib and II which are moderately to highly hazardous; and endosulfan products (banned in the region since 2008). This latter HHP is used by 22% of farmers, and must originate in obsolete stockpiles since it has not been supplied since 2007 – indicating that stockpiles are not secured and continue to expose rural populations.

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

Conclusion Conditions of pesticide use are poor. While basic measures, such as not spraying into the wind, would undoubtedly reduce risks, more important gains are possible by shifting to alternative pest management methods such as IPM and organic. Given the low awareness and experience in these methods and the familiarity and entrenched nature of the existing system, there are many barriers to such systemic change.

Photo: A pesticides store in Senegal.

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Case study 7 Tanzania Country: Tanzania Partner Organisation: TAPOHE Year conducted: 2010 Number of participants: 162 Location: Quang’dend, Mbuga Nyekundu, Mang’ola Barazani and Maleckchand; Karatu, Tanzania Methodology: This community monitoring project carried out by Tanzania Association of Public, Occupational and Environmental Health Experts (TAPOHE) used community self-surveillance templates developed by the UN Food and Agricultural Organisation (FAO) in Asia in 2002, and followed the pesticide practices and health impacts of 162 farmers in four villages of Quang’dend, Mbuga Nyekundu, Mang’ola Barazani and Maleckchand. TAPOHE followed a slightly different approach to the other case studies in that after an initial baseline survey of 222 respondents, the team asked participating farmers to complete their own self-surveillance forms after each spray. Management teams of five community members and two school students (aged 14 – 18 years) provided support, and manually checked and compiled data from the farmers’ forms. Monthly meetings were held to synthesise results with communities and discuss results and spraying practices. Farmers were asked about their experience with the reporting and were questioned about signs and symptoms to ensure they understood their meaning.

The study lasted four months and most farmers (73%) sprayed once or less per week, but a minority (18%) applied pesticides twice per week. Spraying lasted between two and ten hours at an average rate of 100 litres per hour. Since each respondent completed the questionnaire after each spraying, during the four-month surveillance period, the project analysed a total of 1,569 surveillance forms.

Signs and symptoms reported by farmers reporting APP: Health symptoms were observed by all farmers. In order of frequency, symptoms included: exhaustion, dizziness, headache, muscle weakness, runny nose, itching, nausea, blurred vision, red eyes, skin rash, sore throat, muscle cramp, excessive salivation, cough, burning eyes, shortness of breath, burning nose, insomnia. % pesticide users reporting APP: The 162 farmers reported 848 poisoning incidents over the four months with farmers often displaying multiple symptoms. An astonishing 22 incidents involved a loss of consciousness and a further six seizures were reported during this one season. Only 5% of farmers sought medical attention. Farmers explained that they rarely reported poisoning incidents because they thought that it was normal to feel sick when handling pesticides.

Pesticides reported by farmers: Pesticides used by participating farmers included endosulfan (since globally banned) and unregistered products with unknown active ingredients (e.g. ‘Alpha’ or ‘Mukpar’).

Farmers often mixed different pesticides in one spray. These mixtures often involved the same active ingredient – this is counter to the label instructions and results in large overdoses. One common combination (Dursban + Selecron + Profectron + Fenom C) corresponds to chlorpyrifos+ profenofos + profenofos + (profenofos+ cypermethrin) i.e. triple application of profenofos, a WHO Class II cholinesterase inhibitor which is likely to result in very high residues and releases to the environment. Moreover, it was common for farmers to apply pesticides registered for use on animals (such as chlorfenvinphos in Steladone®) on plants such as onions and other vegetables. They were also using formulations for ultra-low volume sprayers in high volume sprayers which resulted in higher application rates. A baseline survey showed that the majority of farmers (66.1%) could not read or extract information from pesticide

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ACUTE PESTICIDE POISONING AMONG SMALLHOLDER FARMERS AND FARMWORKERS

labels and as a result, farmers tended to rely on pesticide dealers and peers when making decisions on which pesticides to use and which dosages to apply.

Conclusion This study collected a lot of detail on the use patterns and exposure. The data is particularly compelling because it involved farmers recording their symptoms after each spray, rather than having to recall symptoms from an earlier exposure incident. It reveals that farmers have very little access to information on pesticide hazards and recommended use. As a result, poor practices such as mixing multiple pesticides and applying incorrect doses were common. All of the farmers in the study experienced pesticide poisoning with some farmers experiencing multiple episodes. Some of the poisonings were severe, resulting in loss of consciousness or seizures.

Photo: Women in Arusha, Tanzania. Credit: Blue Ox Studio

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Discussion The case studies presented in this report all show that acute pesticide poisoning affects a significant proportion of the farmers questioned (Table 5). The study which recorded the lowest level of APP was from Moldova where 10% of respondents said they experienced poisoning, meanwhile 82% of respondents in Belarus reported a poisoning event in the previous 12 months. Both of these surveys had low sample sizes.

TABLE 5. SUMMARY OF RESULTS OF SURVEYS OF SMALLHOLDER FARMERS WHO USE PESTICIDES, SHOWING % SELF REPORTING INCIDENTS OF ACUTE PESTICIDE POISONING OVER A 12 MONTH PERIOD. YEAR

COUNTRY

N (PESTICIDE USERS)

% APP

2011

Mali

357

25

2015

Armenia

25

44

2015

Belarus

49

82

2015

Georgia

117

14

2015

Moldova

73

10

2015

Kyrgyzstan

124

56

2015

Ukraine

161

59

2016

Georgia

591

20

2016

Benin

493

42

2018

Ethiopia

90

28

2018

Benin

507

51

Just three studies revealed poisoning rates of less than 20%, while more than half of the surveys uncovered rates in excess of 40%. Many of these poisonings involved “minor” and general symptoms such as headaches or dizziness, but the studies also uncovered many serious incidents including loss of consciousness and seizures. The studies also showed that a significant minority of farmers experience multiple poisoning incidents in a year. In Benin for example, around a fifth of farmers questioned reported experiencing more than six poisoning incidents in the previous year.

Some of the case studies presented explored the “conditions of use” – the way that pesticides are used in reality – to identify common routes of exposure and risky practices or behaviour that can lead to poisoning. This information is helpful to guide policy makers in targeting interventions to reduce poisonings. These show that many of the assumptions made by regulators when approving pesticides for use in their countries – such as access to PPE, training and information – are not valid. In Tanzania for example, farmers regularly mix the same type of insecticides or different insecticides in a spray. And very few farmers use internationally recognised PPE. Just 6% of farmers in Mali and 0.2% of the farmers questioned in Georgia used PPE. Other common practices identified included spraying into the wind, reusing pesticide containers, storing pesticides at home, repackaging pesticides into other containers, and using pesticides licensed for use on animals on food crops.

Alarmingly, some, of the studies revealed that vulnerable groups such as pregnant women and children work with pesticides. Over a third of the children questioned in the Moldovan case study, and a quarter of those questioned in Kyrgyzstan reported handling pesticides. The risk to farming families and communities living on or near these farms is significant. The study in Senegal showed that 7% of women surveyed reported acute pesticide poisoning incidents despite the fact that they did not themselves apply pesticides.

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A striking finding was that hardly any of those poisoned sought professional medical treatment. Just 5% of farmers poisoned in Tanzania, and just 8% in Mali visited a hospital. Even in relatively wealthy Georgia, just 12% of those who said they had experienced APP sought medical help. This could be because health coverage is poor in many of these countries and the incidents occurred far from the nearest health workers; or it could be because treatment is expensive and most of the farmers lack resources to pay for it; or it could simply be because – as the study found in Tanzania – farmers simply expect to feel ill after applying pesticides so it is considered normal. Whatever the reason, the result is that most poisoning events do not enter official records and as a result are under-reported and the problem rarely comes to the attention of policy-makers.

Pesticide poisoning is a hidden health crisis. None of the countries listed in this study had adequate post-registration monitoring systems. Most had no system at all for recording deaths or ill health associated with pesticide use. Yet, the studies support the conclusion that acute pesticide poisoning in smallholder farming is common. In six out of 10 countries in the study, prevalence rates among farmers and farm workers who apply pesticides were over 40%. And the high poisoning rates uncovered by these studies are not exceptional. Other recent surveys that have uncovered high rates of poisoning include Bangladesh (85%), India (94%), Pakistan (100%) and Tanzania (93%) (Miah41 et al., 2014; Singh42 and Kaur, 2012; Tahir43 and Anwar, 2012; Lekei44 et al., 2014b).

Worldwide there are more than 500 million small/family farms (Lowder45 et al., 2016). If this level of APP is mirrored in smallholder farming globally, it suggests that more than 200 million farmers could be poisoned by pesticides every year. The problem of occupational exposure to pesticides is huge.

All of the studies presented here were conducted by civil society organisations, sometimes in collaboration with national authorities, to gather data and to bring it to the attention of different sectors, including health and agriculture.

The conclusions that we have drawn from these experiences include: 66 Acute pesticide poisoning is a widespread and serious problem 66 Women and children are at significant risk, but data is generally lacking on the extent of their exposure to pesticides 66 Common issues face many countries where farmers lack access to good quality training or information about the hazardous pesticides they are offered. They also lack appropriate PPE and the regulation and management of pesticides is weak 66 The proportion of incidents of pesticide poisoning that reach medical services is low in many countries 66 Health systems often lack the means to diagnose and report incidents of pesticide poisoning to national authorities. Low numbers of reported incidents, therefore, do not reflect the true scale of the problem 66 Better information on pesticide poisoning and its causes can help policy-makers to target more effective action and encourage them to allocate resources to tackle the problem These studies support the conclusions drawn by a report presented to the UN Human Rights Council in 201746 which pointed out that people and the environment are still being failed in terms of protection from hazardous pesticides. And that implementing the right to adequate food and health requires proactive measures to eliminate harmful pesticides.

Many policy-makers and regulators assume that mitigation measures are in place to adequately manage the risks to human health and the environment from pesticides. But these studies clearly show that, in many LMICs, under “real-life” conditions of use, even the most basic risk mitigation measures are not widely adopted.

In the absence of this assumed protection, the most effective way to protect human health and the environment is to ban HHPs and only allow the use of those pesticides which do not require extra mitigation measures. Alternative, low risk and effective pest management approaches are available, but

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coordinated action is needed to harness the resources and will of stakeholders at all levels to achieve a significant shift away from HHPs and towards agroecological farming methods. This includes global actors and frameworks, national authorities, the agricultural research community, the private sector, civil society and rural communities themselves.

Photo: The conditions of use and sale of pesticides in Armenia, often repacked and sold in non-original containers. Credit: PAN UK

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Photos, clockwise from top: Delphine Bodjrenou (Obepab) completes an online survey on her phone with Aziadougan Tadogbe Calixte, a cotton farmer from Djidja, Benin. Credit PAN UK; Interviewing about an incident of pesticide poisoning in Georgia. Credit: PAN UK; Surveying teenagers at school in Ukraine about their exposure to pesticides. Credit PAN UK; Baby playing with empty pesticide containers in Benin. Credit PAN UK / Obepab; Jidago Moise (left) and his wife Kenon Celestine (right) from Gahoungagon in Djidja meet with DieudonnĂŠ Binonwa (centre), a field agent and part of the survey team in Benin. Jidago and Celestine are cotton farmers who shared information about the pesticide poisoning incident in which their son, very sadly, died. Credit: PAN UK

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Keith Tyrell, Sheila Willis and Rina Guadagnini

Acute pesticide poisoning among smallholder farmers and farmworkers September 2020 ISBN 978-1-5272-6259-1 Š This working paper is copyright of the authors

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