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      Cumulative exposure characteristics of vegetable farmers exposed to Chlorpyrifos in Central Java – Indonesia; a cross-sectional study

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          Abstract

          Background

          Agriculture is a major economic sector in Indonesia. Chemical pesticides are widely being used in agriculture for controlling pest. There is a growing concern that pesticide exposure, particularly chlorpyrifos (CPF) exposure, combined with other occupational characteristics that determine the level of exposure, can lead to further health impacts for farmers. Our objective was to evaluate the cumulative exposure characteristics among farmers exposed to CPF by using a validated algorithm.

          Methods

          We conducted a cross-sectional study of 152 vegetable farmers aged 18–65 who actively used CPF for at least 1 year in Central Java, Indonesia. Subject characteristics were obtained using a structured interviewer-administered questionnaire, addressed for sociodemographic and work-related characteristics. The cumulative exposure level (CEL) was estimated as a function of the intensity level of pesticide exposure (IL), lifetime years of pesticide use and the number of days spraying per year. CEL was subsequently classified into two groups, high and low exposure groups. The difference in characteristics of the study population was measured using Chi-square, independent-t or Mann-Whitney test. Association between CEL and its characteristics variables were performed by multiple linear regression.

          Results

          Seventy-one subjects (46.7%) were classified as the high exposure group. The use of multiple pesticide mixtures was common among our study population, with 94% of them using 2 or more pesticides. 73% reported direct contact with concentrated pesticides product, and over 80% reported being splashed or spilt during preparation or spraying activity. However, we found that the proportion of proper personal protective equipment (PPE) use in our subjects was low. Higher volume of mixture applied ( p <  0.001) and broader acres of land ( p = 0.001) were associated with higher cumulative exposure level, while using long-sleeved clothes and long pants ( p <  0.05) during pesticide spraying were associated with lower cumulative exposure after adjusted for age and gender.

          Conclusions

          These findings indicate an inadequate knowledge of using pesticides properly. Thus, we recommend comprehensive training on pesticide usage and encourage proper PPE to reduce the exposure level.

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          Most cited references31

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          Exposure to pesticides and the associated human health effects.

          Pesticides are used widely to control weeds and insect infestation in agricultural fields and various pests and disease carriers (e.g., mosquitoes, ticks, rats, and mice) in houses, offices, malls, and streets. As the modes of action for pesticides are not species-specific, concerns have been raised about environmental risks associated with their exposure through various routes (e.g., residues in food and drinking water). Although such hazards range from short-term (e.g., skin and eye irritation, headaches, dizziness, and nausea) to chronic impacts (e.g., cancer, asthma, and diabetes), their risks are difficult to elucidate due to the involvement of various factors (e.g., period and level of exposure, type of pesticide (regarding toxicity and persistence), and the environmental characteristics of the affected areas). There are no groups in the human population that are completely unexposed to pesticides while most diseases are multi-causal to add considerable complexity to public health assessments. Hence, development of eco-friendly pesticide alternatives (e.g., EcoSMART) and Integrated Pest Management (IPM) techniques is desirable to reduce the impacts of pesticides. This paper was hence organized to present a comprehensive review on pesticides with respect to their types, environmental distribution, routes of exposure, and health impacts.
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            Farmers’ Exposure to Pesticides: Toxicity Types and Ways of Prevention

            Synthetic pesticides are extensively used in agriculture to control harmful pests and prevent crop yield losses or product damage. Because of high biological activity and, in certain cases, long persistence in the environment, pesticides may cause undesirable effects to human health and to the environment. Farmers are routinely exposed to high levels of pesticides, usually much greater than those of consumers. Farmers’ exposure mainly occurs during the preparation and application of the pesticide spray solutions and during the cleaning-up of spraying equipment. Farmers who mix, load, and spray pesticides can be exposed to these chemicals due to spills and splashes, direct spray contact as a result of faulty or missing protective equipment, or even drift. However, farmers can be also exposed to pesticides even when performing activities not directly related to pesticide use. Farmers who perform manual labor in areas treated with pesticides can face major exposure from direct spray, drift from neighboring fields, or by contact with pesticide residues on the crop or soil. This kind of exposure is often underestimated. The dermal and inhalation routes of entry are typically the most common routes of farmers’ exposure to pesticides. Dermal exposure during usual pesticide handling takes place in body areas that remain uncovered by protective clothing, such as the face and the hands. Farmers’ exposure to pesticides can be reduced through less use of pesticides and through the correct use of the appropriate type of personal protective equipment in all stages of pesticide handling.
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              A quantitative approach for estimating exposure to pesticides in the Agricultural Health Study.

              We developed a quantitative method to estimate long-term chemical-specific pesticide exposures in a large prospective cohort study of more than 58000 pesticide applicators in North Carolina and Iowa. An enrollment questionnaire was administered to applicators to collect basic time- and intensity-related information on pesticide exposure such as mixing condition, duration and frequency of application, application methods and personal protective equipment used. In addition, a detailed take-home questionnaire was administered to collect further intensity-related exposure information such as maintenance or repair of mixing and application equipment, work practices and personal hygiene. More than 40% of the enrolled applicators responded to this detailed take-home questionnaire. Two algorithms were developed to identify applicators' exposure scenarios using information from the enrollment and take-home questionnaires separately in the calculation of subject-specific intensity of exposure score to individual pesticides. The 'general algorithm' used four basic variables (i.e. mixing status, application method, equipment repair status and personal protective equipment use) from the enrollment questionnaire and measurement data from the published pesticide exposure literature to calculate estimated intensity of exposure to individual pesticides for each applicator. The 'detailed' algorithm was based on variables in the general algorithm plus additional exposure information from the take-home questionnaire, including types of mixing system used (i.e. enclosed or open), having a tractor with enclosed cab and/or charcoal filter, frequency of washing equipment after application, frequency of replacing old gloves, personal hygiene and changing clothes after a spill. Weighting factors applied in both algorithms were estimated using measurement data from the published pesticide exposure literature and professional judgment. For each study subject, chemical-specific lifetime cumulative pesticide exposure levels were derived by combining intensity of pesticide exposure as calculated by the two algorithms independently and duration/frequency of pesticide use from the questionnaire. Distributions of duration, intensity and cumulative exposure levels of 2,4-D and chlorpyrifos are presented by state, gender, age group and applicator type (i.e. farmer or commercial applicator) for the entire enrollment cohort and for the sub-cohort of applicators who responded to the take-home questionnaire. The distribution patterns of all basic exposure indices (i.e. intensity, duration and cumulative exposure to 2,4-D and chlorpyrifos) by state, gender, age and applicator type were almost identical in two study populations, indicating that the take-home questionnaire sub-cohort of applicators is representative of the entire cohort in terms of exposure.
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                Author and article information

                Contributors
                jenfuk.dr@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                5 June 2021
                5 June 2021
                2021
                : 21
                : 1066
                Affiliations
                [1 ]GRID grid.9581.5, ISNI 0000000120191471, Doctoral Program, Faculty of Medicine Universitas Indonesia, ; Jakarta, 10430 Indonesia
                [2 ]GRID grid.443384.c, ISNI 0000 0000 8489 4603, Department of Occupational Health and Safety, , Faculty of Medicine and Health Science Universitas Kristen Krida Wacana, ; Jakarta, 11510 Indonesia
                [3 ]GRID grid.9581.5, ISNI 0000000120191471, Community Medicine Department, , Faculty of Medicine Universitas Indonesia, ; Jakarta, 10320 Indonesia
                [4 ]GRID grid.9581.5, ISNI 0000000120191471, Department of Internal Medicine, , Faculty of Medicine Universitas Indonesia, ; Jakarta, 10430 Indonesia
                [5 ]GRID grid.9581.5, ISNI 0000000120191471, Department of Pharmacology and Therapeutics, , Faculty of Medicine Universitas Indonesia, ; Jakarta, 10430 Indonesia
                [6 ]GRID grid.9581.5, ISNI 0000000120191471, Department of Biology, , Faculty of Medicine Universitas Indonesia, ; Jakarta, 10430 Indonesia
                [7 ]GRID grid.418754.b, ISNI 0000 0004 1795 0993, Eijkman Institute for Molecular Biology, National Research and Innovation Agency, ; Jalan Diponegoro No. 69, Kota Jakarta Pusat, Jakarta, Indonesia
                [8 ]Prodia Occupational Health Institute International, Jakarta, 10430 Indonesia
                Article
                11161
                10.1186/s12889-021-11161-5
                8178818
                34090393
                84de1013-1029-4e95-89fd-8b0168dc009c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 March 2021
                : 27 May 2021
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Public health
                pesticide cumulative exposure,exposure assessment,exposure reduction,work practices,occupational characteristics

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