|Year : 2018 | Volume
| Issue : 4 | Page : 153-161
Assessment of Adverse Health Effects Among Chronic Pesticide-Exposed Farm Workers in Sagar District of Madhya Pradesh, India
Rajesh K Kori1, Ravindra S Thakur1, Ravi Kumar2, Rajesh S Yadav1
1 Department of Criminology and Forensic Science, School of Applied Sciences, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India
2 Department of Criminology and Forensic Science, School of Applied Sciences, Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, School of Allied Health Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
|Date of Web Publication||26-Dec-2018|
Rajesh S Yadav
Department of Criminology and Forensic Science, School of Applied Sciences, Dr. Harisingh Gour Central University, Sagar 470 003, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The extensive and injudicious use of pesticides in agriculture, household, veterinary practices, and occupational settings have increased the risk of human exposure and associated health effects. Objectives: In the present study, an attempt has been made to investigate the toxic symptoms, including neurological effects in pesticide-exposed farm workers. Methods: The data of exposure pattern and symptomatic health effects were collected through questionnaire distributed among 248 male farm workers by purposive sampling method from the district Sagar (MP), India. The mean value of chronic exposure index was 1.710 indicates that the farm workers were chronically exposed to hazardous pesticides. Results: Adverse health effects in farm workers including tingling (32.3%), muscle pain (51.6%), headache (56.5%), skin disease (19%), blurred vision (35.5%), tremor (23%), stress (24.2%), depression (15.3%), anxiety (44.7%), altered taste (21.4%), altered smell (31.4%), sleep disorder (39.5%), dizziness (66.1%), memory problems (29.4%), trouble in walking (8%), and cardiac problems (16.9%) were reported. The effects were more prominent in farmers who are smokers, residing at farm and store pesticide at home. In addition, the use of protective measures was not proper due to which the adverse effects were seen almost equal in most of the cases or even higher in some cases who reported to use protective measures. Conclusions: Farm workers are at the higher risk of exposure, as they are unaware and do not use proper protective measures for the same. Regular monitoring of occupational exposure by the regulatory agencies is necessary to minimize adverse health effects of pesticides.
Keywords: Chronic exposure, farm workers, health risk, pesticides, toxicity
|How to cite this article:|
Kori RK, Thakur RS, Kumar R, Yadav RS. Assessment of Adverse Health Effects Among Chronic Pesticide-Exposed Farm Workers in Sagar District of Madhya Pradesh, India. Int J Nutr Pharmacol Neurol Dis 2018;8:153-61
|How to cite this URL:|
Kori RK, Thakur RS, Kumar R, Yadav RS. Assessment of Adverse Health Effects Among Chronic Pesticide-Exposed Farm Workers in Sagar District of Madhya Pradesh, India. Int J Nutr Pharmacol Neurol Dis [serial online] 2018 [cited 2019 Sep 20];8:153-61. Available from: http://www.ijnpnd.com/text.asp?2018/8/4/153/248540
| Introduction|| |
India is an agrarian country; about 65% of the total population lives in the villages with around 48.9% of its population depending directly or indirectly on the agriculture for their earning. The agricultural workers are moving toward the use of pesticides for maintaining the food security, protection of crop from the pests, and increasing the yield. These pesticides are chemical substance or mixture of chemical substances intended for preventing, destroying, or controlling any pest which is harmful for the crops. Use of chemical pesticides per hectare in India is almost two-fold greater than the developed countries. The intensive use of pesticides gave rise to serious problems for the food chain and ecological environment due to the presence of pesticides residues in food and other body tissues. Improper use of pesticide may cause poisoning in human, as a residue it accumulates in food and in the environment which also lead to the development of resistance in pests. Pesticides exert their harmful effects on both the human and the environment.
It is widely recognized that the farm workers are at the highest risk of occupational exposure of pesticides facing adverse health effects due to inappropriate protective measures including inadequate clothing, pilferage, drift of spray droplets, leak and other defects in spray equipment, or other reasons.,, In contrast, families residing near or within the farm are exposed to pesticides through dust, air, vapor, etc., and general population is at the risk of pesticide poisoning through indirect use such as household pesticide use, contaminated food, water, soil, air, dust, or accidental poisoning.,, The cases of farmer suicide is also increasing in our country now a days, 5650 farmers have committed suicides during 2014, accounting for 4.3% of total suicides victims in the country. Moreover, the WHO has systematically classified different pesticides on the basis of their health hazard, which consist pesticides from extremely hazardous to unlikely to present acute hazard. The Food and Agriculture Organization recommended the promotion of less toxic pesticides, environmental friendly, show least accumulation, and require little protective equipments to the government in developing countries. However, many pesticides used in these countries are comes under the category of extremely or highly hazardous.
Epidemiological research to assess occupational exposure of pesticides on a population of agricultural workers is matter of complexity, because it generally concerns with exposure to a mixture of agents. Furthermore, involvement to uptake through the different exposure routes (skin, respiratory, and gastrointestinal tract) depends on physicochemical properties of the pesticides. Studies have also reported that exposure to pesticides in farm workers could be a significant risk factor for neurological disorders, including Parkinson’s and Alzheimer’s disease. Agricultural workers often farm without the suitable means and knowledge to use pesticides appropriately., Personal factors such as lack of protective measures, mixing with bare hands, and lack of hygienic precautions during and when spraying; environmental factors like high temperature, windy weather; and occupational conditions consisting inaccurate quantity, wrong timing and targeting, inadequately maintained equipment, etc. may be contributing factors to enhance the toxicity., In the absence of proper handling of pesticides, not only the health of agricultural workers, but also the health of their families is at risk.,,
Chronic health effects in humans are likely to result from risky pesticide exposure that might occur in occupational situations. However, malnutrition, dehydration, ill health, and high temperatures, which are common in developing countries, are likely to increase sensitivity to pesticides., In view of the increased risk of exposure of pesticide in agriculture workers, the present study has been focused to investigate the self-reported toxicity symptoms of pesticide toxicity in agriculture workers to find out the exposure pattern, factors involved, and adverse health effects through a questionnaire-based study.
| Materials and methods|| |
The study was conducted in the Bundelkhand region in nearby and remote villages of Sagar district, India. The nearby villages of the Sagar city within 5-km range are Pathariya Jaat, Sironja, Berkheda, Patkui, and Bararu. A total 465 participants were selected for the present study. Out of which 380 participants responded and participated in which 265 were found to involve in the uses of pesticide since last more than 5 years and therefore included in the study. The numbers of female workers were very less (17) and therefore excluded from the study and only 248 male farm workers were included in the present study [Figure 1]. The study has been conducted at specific times when pesticide applications at their peaks. Pesticide users (aged between 17 and 75 years), directly involved in the intensive cultivation of crops and vegetables, were asked to take part in the study. All the participants were informed about the study before taking their information.
Questionnaire and interviews
In the present study, we used the questionnaire for interview the participants to obtain the data from agricultural workers. The questionnaire was based on the living conditions, awareness, economic status, handling, practice and decontamination, methods of pesticide use, and health status of the participants. It consists a personal information such as name, age, gender, education, residence, area of the farm, addiction, contact address; information about pesticide use such as crop, pesticide name, content, amount, spraying method, duration of use, years of using pesticide, and time spend on the farm. It also includes the precautions they were taking, such as training, guidance, storage of pesticide, protective equipments, decontamination, and mischief. The interview of each participant was performed by face-to-face interaction. A structured questionnaire for health examination was administered to collect data on standard demographic features, physical examination, alcohol and smoking habits, and occupational data from all individuals. The questionnaire includes the symptoms relevant to pesticide toxicity are tingling, muscle pain, headache, skin diseases, tremor, confusion, stress, dizziness, memory recall problem, anxiety, sleep disorder, trouble in walking, tastelessness, lower smell sense, memory recall problems, trouble in walking, and cardiac problems in the farm workers involved in the use of pesticides. The details of any illness, including blood pressure, disease condition such as diabetes, neurological disorders, and family history, were also asked during the interview. They were also asked if they had ever suffered from pesticide poisoning.
Chronic exposure deals with the ability of a pesticide to cause toxic effects over an extended period of time, usually after repeated or continuous exposure, which may last for the entire life of the exposed organism. The exposure index of pesticide-exposed farm workers that measured the relative levels of chronic occupational exposure to pesticide was calculated as follows:
where Y is the number of years of occupational exposure to pesticide and D is the most recent estimate of the number of days of usage of pesticide per year. Index values from 0.698 to 2.757 (median to highest value) were classed as high chronic exposure; those from 0.698 to 0.000 (median-to-lowest value) were classed as low chronic exposure., In the present study, we have divided chronic exposure into medium (0.698–1.710) and high exposure (1.711–2.757) to assess the adverse health effects in association with chronic exposure.
Statistical analysis of the data was conducted using the SPSS software (IBM SPSS Statistics version 20.0, IBM Corporation, Armonk, New York, USA). The frequency of the various symptoms with respect to the number of participants was calculated. Cross tabulation of toxicity symptoms with the other variables was also calculated by using Chi-square (χ2) test with descriptive statistics and represented.
| Results|| |
Agricultural workers are at higher risk of exposure as they are unaware, have no training or guidance of pesticide spraying, and do not use protective measures for the same. Most of the workers had a superficial knowledge about the detrimental health effects of pesticide but were not well aware of the safety precautions regarding pesticide handling. The result of preliminary study clearly indicates that the agricultural workers were chronically exposed to pesticides as evident by the toxic effects, including tingling, muscle pain, headache, numbness, eye irritation, skin disease, anxiety, nausea, depression, etc.
Demographic profile and lifestyle characteristics of the pesticide-exposed farm workers
The detailed demographic profile of pesticide-exposed agriculture workers is represented in [Table 1]. Gender, age group, educational status, area of residence, addiction habits, place of pesticide storage, and years of exposure were included in the study. In our study, 265 farm workers stated that they were using pesticide and involved in spraying, mixing, and loading of pesticides during agricultural activities. There were 248 male and 17 female workers who participated in the study. As the number of female farm workers was very less, we have excluded them from the study and only 248 male farm workers were included in the present study. Most of the male workers were used pesticides for over 10 years and exposed through it while working about 5 to 8 h a day during the growing season. The mean chronic exposure level was found 1.71 that showed high chronic exposure of pesticide in farm workers. The chronic exposure category was further divided into two categories to find out the intensity of the association between exposures with other variables.
|Table 1: Demographic profile and lifestyle characteristics of the pesticide exposed farm workers|
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Details of pesticide used their type and active ingredients
The type of pesticides used in Sagar district of Madhya Pradesh, India, is given in [Figure 2]. Most of the pesticides were from the insecticide category and classified as a classes Ib and II category by WHO. Few of them were mixed of both organophosphate and pyrethroid. The farm workers are using these pesticides and their mixture without any proper precautions and are at higher risk of exposure to develop adverse clinical consequences. The use of insecticide was found to be different and from its various categories consumption. The use of organophosphate was 19%, 23%, 18%, and 27% from Ia, Ib, II, and III category of WHO, respectively. Pyrethroid use was 7% and 34% from classes Ib and II, respectively. The carbamate use was 4%, 9%, and 27% from classes Ia, Ib, and II, respectively, whereas use of organochlorine was 9% only from class II [Figure 2].
Symptoms of adverse health effects due to the pesticide exposure in farm workers
Adverse health effects and neurological end points were assessed through self-reported symptoms conducted by clinical and physical examination of pesticide-exposed farm workers and represented in [Table 2]. A variety of clinical symptoms, including tingling (32.3%), muscle pain (51.6%), headache (56.5%), skin disease (19%), blurred vision (35.5%), tremor (23%), stress (24.2%), depression (15.3%), anxiety (44.7%), altered taste (21.4%), altered smell (31.4%), sleep disorder (39.5%), dizziness (66.1%), memory problems (29.4%), trouble in walking (8%), and cardiac problems (16.9%) have been reported in pesticide-exposed individuals. The adverse clinical symptoms reported in the present study could be linked with chronic pesticide exposure [Table 2].
|Table 2: Self-reported adverse health effects in male farm workers due to the pesticide exposure|
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Adverse health effects associated with age groups in pesticide-exposed farm workers
The adverse health effects with association of age groups have been represented in [Table 3]. Farm workers were classified into three age groups: ≤30, 31 to 45, and ≥46 years old. The self-reported adverse health effects were found to be higher in the ≥46-year old group. The adverse effects including headache (62.3%), muscle pain (61%), anxiety (56.2%), and dizziness (71.3%) were found to be more prominent in the ≥46-year old group [Table 3].
|Table 3: Association of adverse health effects with age groups in pesticide exposed farm workers|
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Adverse health effects associated with the drug habits of pesticide-exposed farm workers
This is assessed to ensure their habit of taking different intoxicant and their effect on them during the use of pesticide. Participants reported that they were taking tobacco and smoking cigarette during spraying and also take alcohol for relaxation. The adverse effects were found to be more prominent in the adductors in comparisons to those who are not involved in any type of addiction habits. The following table clearly mentioning the percentage change in alcoholics, tobacco chewers, smokers, and those who are not taking these drugs. The data of the present study reveal that the addictive habits like smoking may positively correlate with the adverse health effects during pesticide exposure, and this could be taken into consideration while implementing protective measures [Table 4].
|Table 4: Association of adverse health effects with the drug habits in pesticide exposed farm workers|
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Adverse health effects associated with the residence and storage of pesticides by the farm workers
It has been assessed to know the preoccupational exposure of pesticides and the environment of their residential area, whether it is affected by pesticide or not. The percentage change of adverse health effects was found higher in farm workers, those residing at the farm except in few cases including tremors, confusion, and sleep disorder. These results showed that the risk of exposure is quite high in those who are residing on the farm, and this is reflected in terms of toxic effects in them [Table 5].
|Table 5: Association of adverse health effects with the residence and storage of pesticide in exposed farm workers|
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At the same time, the storage of pesticide at home is also positively correlated with the adverse health effects as evidenced by the increase percentage change in them. It also further strengthens the result that risk of exposure increase with the accessibility of positive and direct contact with the pesticide. It is assessed to know their practice and awareness toward the storage of pesticides and the precautions they are taking for this purpose [Table 5].
Adverse health effects associated with the use of protective measures by the farm workers
The assessment about the protective equipments used by farmers and consecutive adverse health effects was conducted and represented in [Table 6]. The use of protective measures and equipment does not show any significant protection in the health effects. It clearly suggests that the protective methods or equipments are not proper. The farmers told during the interview that they use a cloth to wrap around the mouth and nose and wash their hands or take a bath after the spraying. Only few of them reported to wear shoes, but those are not proper. Due to all these inefficient protective measures, the adverse health effects still reported quite high in those who said that they are using protective measures. This is due to the unawareness and low knowledge about the toxicity which is again a matter of great concern [Table 6].
|Table 6: Association of adverse health effects with the use of protective measures in pesticide exposed farm workers|
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Severity of adverse health effects in low to medium and high chronic exposed farm workers
In the present study, the mean value of chronic exposure index was 1.710, which reveals the higher chronic exposure among agriculture workers and could be associated with the adverse health effects in them. The maximum health effect has been seen in headache (56.5%), muscle pain (51.6%), blurred vision (35.5%), anxiety (44.7%), sleep problem (39.5%), and dizziness (66%). The adverse health effects were more prominent in the farm workers who have high chronic exposure as compared to low or medium-exposed population [Table 7].
|Table 7: Severity of adverse health effects in medium and high chronic-exposed farm workers|
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| Discussion|| |
Epidemiological studies have suggested that the exposure of pesticide to human are associated with different types of cancers, neurologic disorders, respiratory problems, hormonal, and reproductive abnormalities; hence, the public health has an increasing concern among the health scientists. Pesticides are known to cause abnormalities in the eyes associated with blurred vision, lacrimation, pain in the eyes, red swollen eyes, and irritation of eyes, following pesticide exposure, and this was higher among the spraying workers., Skin rashes and skin itchiness were also found among agricultural workers to be significantly associated with pesticide spraying. The study has also reported that the allergic contact dermatitis significantly associated with pesticide exposure among agricultural workers. Agricultural workers are at higher risk of exposure as they are unaware, have no training or guidance of pesticide spraying, and do not use protective measures for the same. Most of the workers had frivolous knowledge about the detrimental health effects of pesticide but were not well aware of the safety precautions regarding pesticide handling. As a result of pesticide exposure, farmers and agricultural worker mainly experienced muscle pain, weakness, easily became tired, felt fatigue, change in taste, experience of eye pain, headache, drowsiness, and tremors, eye pain, headaches and tremors, palpitations, throat irritation, and sweating.,, Health effects resulting from pesticide exposure may vary depending on each individual pesticide involved and may be the outcome of exposure via the dermal, oral, or inhalational routes; however, dermal exposure is known as the most important route of exposure for pesticide applicators.
Pesticide poisoning may be acute or chronic depending upon the dose and time of exposure. Long-term low-dose exposure to pesticides leads to the development of various health-related problems including asthma, reduced sperm quality and sperm count, causing sterility; affect the human endocrine and immune systems; promote the development of cancer, etc. Workers with long-term exposure to organophosphorus pesticides have reduced humoral, cell-mediated immunity, and neurological dysfunctions. In the present study, the mean value of chronic exposure index was 1.710, which reveals the higher chronic exposure among agriculture workers and could be associated with the adverse health effects in them. The adverse health effects were more prominent in the farm workers who have high chronic exposure as compared low or medium exposed population.
However, there were very limited similar kinds of studies, but certain earlier studies show some agreement with our study. Earlier studies have reported that the agricultural workers exposed to hazardous pesticides showed adverse health effects, including muscle pain, headache, tingling/numbness, eye irritation, skin disease, anxiety/confusion, fever, altered taste, tremor, nausea and depression, etc.,,, In the present study, most of the agricultural workers are illiterate (40.3%) due to which they do not able to read the information on label and didn’t have enough knowledge about pesticide use. Most of the affected persons were from remote villages which is far backward than near villages to city area. Some of the workers don’t know anything about the pesticides and accidently, unknowingly exposed to pesticides along with their families. These agricultural workers spray pesticides without any safety measures with bare eyes, hands, foot, nose, skin, etc. In our study, we found adverse health effects including tingling, headache, muscle pain, skin problems, blurred vision, tremor, anxiety, depression, stress, altered taste and smell sense, memory problems, and cardiac problems among agricultural workers.A number of risk factors including addiction habit, health condition, storage of pesticide, residence, amount of pesticide use, time spent at farm, use of protective measures have been found to be associated with the adverse health effects in farm workers.,, In the present study, the addiction of alcohol and tobacco consumption showed no association on the enhancement of adverse health effects, whereas smoking is found one of the factors to increase the risk of toxicity in case of headache, muscle pain, tremor, stress, altered taste, sleep problem, trouble walking, and cardiac problems. At the same, time the residence at farm also found to increase the risk of tingling, whereas storage of pesticide at home has been associated with the risk of skin disease, stress, anxiety, altered smell sense, and sleep problem.
Studies have been reported that incomplete protection, wiping sweat with a piece of residue contaminated fabric, reentering recently sprayed area, dermal contact with spills from leakage of backpack sprayers, and other spills, whereas mixing pesticides are the main risk factors for the development of toxicity.,,, Mixing of two or more than two pesticides in a single container may cause synergistic effect and become more toxic,, as individuals believe such formulations are more potent in killing pests. This may enhanced the toxic effects due to synergistic action and cause illness. In the present study, no specific changes in adverse effects were observed in the farm workers using the protective measures or those who are not using protective measures that clearly suggest the improper protection. The farm workers reported that they are only using the cloth to wrap their mouth and nose and no specific protection including gloves, shoes, masks, personnel protective equipment, etc. was used by them. Due to which the effects were seen equal in both the cases and even higher in some cases such as skin disease and altered smell sense. The risk factors found in the present study were smoking, storage of pesticide, residences of farmers, and use of protection during spraying of pesticides. The adverse changes were also associated with the chronic exposure of pesticides which have been divided into two category of medium and high exposure. It is interesting to note that out of 248 participants, 42 farm workers did not report any adverse health effects. It is difficult to comment due to limitation in the study, but it may be because of their resistance toward pesticide toxicity and needs further investigation.
| Conclusion|| |
The use of organic manure and other cultural methods of pest control were rapidly replaced by pesticides due to easy access, quick action, and high efficacy, and this becomes the high-risk factor for adverse health hazards. Due to the lack of awareness of farmers, the injudicious use of pesticides has become a serious problem in agricultural production. Many of the agricultural workers do not have necessary education and training in the different methods of pesticides application. Safe precautionary methods of pesticide spraying operations in agriculture must be applied for the prevention of agricultural worker from pesticide exposure. Proper monitoring of occupational exposure by the regulatory agencies is necessary to minimize adverse health effects of pesticides. Informing agricultural workers of these findings might help them make a conscious effort to reduce the extent of pesticide use. Furthermore, an occupational health program for surveillance of health among farmers in this region could be implemented to reduce the toxic hazards.
The authors are thankful to Dr. Harisingh Gour Vishwavidyalaya (A Central University), Sagar, MP, India, for providing the opportunity to work and their support and interest.
Financial support and sponsorship
Authors are thankful to the Science and Engineering Research Board, Department of Science and Technology (DST-SERB), New Delhi, for providing Young Scientist research grants. Mr. Rajesh Kumar Kori is thankful to the University Grants Commission (UGC), New Delhi, for providing research fellowship.Conflicts of interest
There are no conflicts of interest.
| References|| |
Economic Survey. Economic survey report 2014–2015. GOI; 2015.
FAO. The State of Food and Agriculture innovation in family farming. Rome: FAO; 2014.
Kori RK, Jain AK, Yadav RS. Biomarkers: An essential gizmo in pesticide toxicity. Biomarkers J 2016;2:1-5.
Hou B, Wu L. Safety impact and farmer awareness of pesticide residues. Food Agric Immunol 2010;21:191-200.
Yassin M, Abu M, Safi J. Knowledge, attitude, practice, and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip. Occup Environ Med 2002;59:387-93.
Banerjee I, Tripathi SK, Roy AS, Sengupta P. Pesticide use pattern among farmers in a rural district of West Bengal, India. J Nat Sci Biol Med 2014;5:313-6.
Mahantesh N, Singh A. A study on farmers’ knowledge, perception and intensity of pesticide use in vegetable cultivation in western Uttar Pradesh. Pusa AgriScience 2009;32:63-9.
WHO/UNEP. Public health impact of pesticides used in agriculture. Geneva: WHO; 1990. pp 85-6.
Wesseling C, McConnall R, Partanen T, Hogstedt C. Agricultural pesticide use in developing countries: Health effects and research needs. Int J Health Serv 1997;27:273-308.
Rohitrattana J, Siriwong W, Tunsaringkarn T, Panuwet P, Ryan PB, Barr DB et al.
OPs pesticide exposure in school-aged children living in rice and aquacultural farming regions of Thailand. J Agromed 2014;19:406-16.
NCRB. Accidental deaths & suicides in India 2014. NCRB MHA GOI; 2014.
WHO. The WHO recommended classification of pesticides by hazard and guidelines to classification. 2009.
FAO. International Code of Conduct on the distribution and use of pesticides. Rome: FAO of the United Nations; 2002.
Yadav SS, Singh MK, Yadav RS. Organophosphates induced Alzheimer’s disease: An Epigenetic Aspect. J Clin Epigenet 2016;2:1.
Jors E, Morant RC, Aguilar GC, Huici O, Lander F, Baelum J et al.
Occupational pesticide intoxications among farmers in Bolivia: A cross-sectional study. J Environ Health 2006;5:10.
Jallow MF, Awadh DG, Albaho MS, Devi VY, Thomas BM. Pesticide knowledge and safety practices among farm workers in Kuwait: Results of a survey. Int J Environ Res Public Health 2017;14:340.
Abate T, van Huis A, Ampofo JK. Pest management strategies in traditional agriculture: An African perspective. Annu Rev Entomol 2000;45:631-59.
Khan M, Damalas CA. Occupational exposure to pesticides and resultant health problems among cotton farmers of Punjab, Pakistan. Int J Environ Health Res 2015;25:508-21.
Williamson S, Ball A, Pretty J. Trends in pesticide use and drivers for safer pest management in four African countries. Crop Protect 2008; 27:13-27.
Macfarlane E, Chapman A, Benke G, Meaklim J, Sim M, McNeil J. Training and other predictors of PPE use in Australian grain farmers using pesticides. Occup Environ Med 2008;65:141-6.
Parron T, Hernandez AF, Pla A, Villanueva E. Clinical and biochemical changes in greenhouse sprayers chronically exposed to pesticides. Hum Exp Toxicol 1996;15:957-63.
Korsak RJ, Sato MM. Effects of chronic organophosphate pesticide exposure on the central nervous system. Clin Toxicol 1977;11:83-95.
Berberian I, Enan E. Neurotoxic studies in humans occupationally exposed to pesticides. Occup Med 1987;37:126-7.
Fareed M, Kesavachandran CN, Pathak MK, Bihari V, Kuddus M, Srivastava AK. Visual disturbances with ChE depletion due to exposure of agricultural pesticides among farm workers. Toxicol Environ Chem 2012;94:1601-9.
Sanyal S, Law A, Law S. Chronic pesticide exposure and consequential keratectasia & corneal neovascularisation. Exp Eye Res 2017;164:1-7.
Weng CY, Black C. Taiwanese farm workers’ pesticide knowledge, attitudes, behaviors and clothing practices. Int J Environ Health Res 2015;25:685-96.
Sharma A, Mahajan VK, Mehta KS, Chauhan PS, Sharma V, Sharma A et al.
Pesticide contact dermatitis in agricultural workers of Himachal Pradesh (India). Contact Dermat 2018;79:213-7.
Mrema EJ, Ngowi AV, Kishinhi SS, Mamuya SH. Pesticide exposure and health problems among female horticulture workers in Tanzania. Environ Health Insights 2017;11:1178630217715237.
Atreya K. Probabilistic assessment of acute health symptoms related to pesticide use under intensified Nepalese agriculture. Int J Environ Health Res 2008;18:187-208.
Kori RK, Singh MK, Jain AK, Yadav RS. Neurochemical and behavioral dysfunctions in pesticide exposed farm workers: A clinical outcome. Indian J Clin Biochem 2018;33:372-81.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]