TABLE OF CONTENT
Table of Content ................................................................................................................................................. 1
Preface ................................................................................................................................................................ 3
Pesticides and occupational health ................................................................................................................. 3
Pesticides ........................................................................................................................................................ 4
Pesticide hazard list ........................................................................................................................................ 4
Uganda and pesticides .................................................................................................................................... 5
Search strategy ............................................................................................................................................... 6
The framework of the project ......................................................................................................................... 6
Article ................................................................................................................................................................. 8
Pesticide use and how it affects the health of small scale farmers in Uganda: a cross-sectional study ......... 9
Abstract .......................................................................................................................................................... 9
Background .................................................................................................................................................. 10
Method ......................................................................................................................................................... 12
Study design ............................................................................................................................................. 12
Setting....................................................................................................................................................... 12
Participants ............................................................................................................................................... 12
Standardized interviews ........................................................................................................................... 13
Exposure variables ................................................................................................................................... 14
Outcome variables .................................................................................................................................... 14
Potential confounders ............................................................................................................................... 15
Statistical method ..................................................................................................................................... 15
Missing data ............................................................................................................................................. 15
Ethical considerations............................................................................................................................... 16
Results .......................................................................................................................................................... 17
Participants ............................................................................................................................................... 17
Crops ........................................................................................................................................................ 17
Pesticides .................................................................................................................................................. 17
Symptoms ................................................................................................................................................. 18
Knowledge ............................................................................................................................................... 18
Practice and attitude ................................................................................................................................. 18
Association between symptoms and pesticide usage ............................................................................... 18
Supplementary analyses ........................................................................................................................... 20
Discussion .................................................................................................................................................... 21
Conclusion.................................................................................................................................................... 24
Tables for Pesticide use by Ugandan small scale farmers: a cross sectional study. ..................................... 25
Table 1 ...................................................................................................................................................... 25
Table 2 ...................................................................................................................................................... 26
Figure 1 .................................................................................................................................................... 27
Table 3 ...................................................................................................................................................... 28
Figure 2 .................................................................................................................................................... 29
Figure 3 .................................................................................................................................................... 30
Table 4 ...................................................................................................................................................... 31
Table 5 ...................................................................................................................................................... 32
Table 6 ...................................................................................................................................................... 34
Table 7 ...................................................................................................................................................... 35
Table 8 ...................................................................................................................................................... 36
Reference List .................................................................................................................................................. 37
Appendix .......................................................................................................................................................... 40
Appendix 1 ............................................................................................................................................... 41
Appendix 2 ............................................................................................................................................... 47
Appendix 3 ............................................................................................................................................... 56
2
PREFACE
PESTICIDES AND OCCUPATIONAL HEALTH
The World Health Organization has estimated a worldwide incidence of 3.000.000 cases of acute and
severe poisoning. 300.000 of these cases are fatal. Nearly all of these deaths occurred in developing
countries. The effortless availability of highly toxic pesticides in farmers’ homes has made pesticides the
most common remedy for suicide [1-3].
Approximately one third of the deaths are due to occupational hazards, as the extensive use of pesticides
exposes farmers to both long term and acute occupational health problems [4, 5]. In addition to this comes
an even greater number of unreported cases of mild-to-moderate intoxication [4, 6, 7].
Medical treatment in the rural areas is difficult since few medical resources are available. Case fatality
rates for pesticide poisoning are often high in developing countries due to lack of the necessary
equipment, medicine and sufficient educated medical staff [5]. The necessity of ensuring agricultural
production and food security in low-income countries while also protecting the population against health
impacts following exposure to pesticides has emerged as a major global public health problem [5].
3
PESTICIDES
Pesticides are poisonous chemicals intended for preventing, destroying or controlling pests during the
production, processing, transporting and marketing of food. This includes vectors of human and animal
disease, unwanted species of plants or animals causing harm during the production, processing, storage,
transport or marketing of food, wood or animal feedstuffs [8]. They are mainly used in agriculture, but
can also be used in health campaigns; e.g. to eradicate vector diseases such as yellow fever and malaria.
Approximately 1.500 active ingredients have been registered as pesticides, and 50.000 commercial
pesticides are registered for use. Because of the enormous number of commercial formulations, pesticides
are available in almost any community [9].
The health effects of pesticides can be divided into acute poisoning and chronic effects. Acute pesticide
poisoning is any illness or health affects appearing shortly after a single or multiple doses of pesticide.
This includes a wide range of reactions in different target organs like neurological, dermal or respiratory.
Chronic poisoning occurs gradually after prolonged exposure to pesticides. Increasing development of
cancer and reproductive abnormalities have been seen in people who have gone through a long-term
exposure to pesticides. This study will focus on the short-term effects of pesticide poisoning [6, 7, 10,
11].
PESTICIDE HAZARD LIST
In an effort to accommodate the improper use of pesticides, the World Health Organisation (WHO) has
made an Essential Drug List (EDL), classifying the pesticides into five groups according to their health
hazards; Ia = Extremely hazardous; Ib = Highly hazardous; II = Moderately hazardous; III = slightly
hazardous; U = Unlikely to present acute hazard in normal use. The hazards described are the acute risks
to one’s health (i.e. the risk that emerges from a single exposure or multiple exposures over a relatively
short period of time). The EDL is primarily based on oral and dermal danger [12]. WHO accentuates the
importance of products classified with a high degree of hazard, especially Ia and Ib, being labelled
correctly. These labels should indicate the high degree of hazard by skull and crossbones pictures and,
furthermore, having colour coding and phrases saying ―toxic‖ or ―poison‖. WHO also accentuates the
importance of labels being formulated in the respective local language. The presentation of the symbol
and phrase should thus provide the user with sufficient knowledge when choosing a pesticide [12]. Some
of the most dangerous classes of pesticides are chlorinated hydrocarbons, organophosphates and
dithiocarbamate pesticides, due to a high index of toxicity [4]. Numerous studies have explored the health
effects of organophosphate in developing countries, and have found an increased risk of pesticide
poisoning [13-15].
The Food and Agriculture Organisation of the United Nations (FAO) indicates that developing countries,
rather than the least developed nations, consumed the majority of reported organophosphates and
4
dithiocarbamates. This finding is not surprising since pesticides are expensive, and older and cheaper
pesticides becomes preferred alternatives to the newer and often safer ones [7].
The pesticide industry is an important player in this problem. The use and selling of pesticides has
become a billion dollar business for many national and international agents. The industry states that they
are fully supporting police restricted use of pesticides. However, the industry’s interests in profit makes
them willing to sell pesticides in developing countries that are already banned in industrialized countries
[5, 11, 16]. This results in products of the most toxic classes, like the ones mentioned above, being sold to
farmers in developing countries [17]. Moreover, if the pesticide industry keeps paying sales persons on a
commission basis, it is unlikely that the dealers will encourage the farmers to use fewer pesticides [4].
The Food and Agriculture Organisation of the United Nations (FAO) has, with its code of conduct, tried
to control the use of pesticides. This code of conduct was one of the first voluntary codes of conduct in
support of increased food security, while at the same time protecting human health and the environment.
The original FAO code of conduct was published in 1985, trying to encourage long-term efforts to
develop legislation, regulations, and infrastructure in order to enforce good pesticide practice [4, 8, 18].
FAO recommend Integrated Pest Management (IPM) to deal with the present pesticide issues. IPM can
reduce the use of agrochemicals, improve management and optimize ecosystem mechanisms for pest
control/soil enrichment, while also protecting both farmers and the environment [5]. Sustainability is
ensured by preparing the communities, building on available local resources and commitments, weaving
IPM into local community development planning processes and situating program concerns within the
local government system [4].
UGANDA AND PESTICIDES
Pesticide use in Africa accounts for 2-4% of the global pesticide market. This is in comparison to 30% in
North America and 16% in Asia [19, 20]. During the period 1993-94, FAO estimated that about 100,000
tons of pesticides were applied in developing countries, of which 20,000 tons were applied in Africa [8,
21]. In Africa, it is estimated that 11 million cases of pesticide overexposure occur annually [4].
Data gathering for the present study has taken place in Uganda. Uganda was one of the first countries to
be included in the Danish programme coordination identified in 1989 after the present Ugandan
government of the National Resistance Movement came to power in 1986. The BNI per capita is around
$350, and 31% live in extreme poverty. The size of the country is 241.551 km2, and the population
density is 123 persons/km2. The population size is about 28 million people, and the fertility rate is 6.5.
The life expectancy is 50 years. The most prevalent diseases are diarrhoea, airway tract infections,
malaria and HIV/AIDS. The illiteracy rate is 31%, and women account for 75% of this [22].
Agriculture plays a vital role of the Ugandan economy. It contributes to roughly 21% of the Gross
Domestic Product, and 85% of the population work either directly or indirectly in the agricultural sector
[21]. Uganda is currently reported to be among one of the countries in Africa with the lowest pesticide
5
usage rate at only 17 kg/ha. However, with a growing population and thereby a growing crop production,
the import of pesticides are increasing. Exact numbers are difficult to acquire, but the import of pesticides
has risen with a factor 47 from 1980 to 2004. On top of that, it is estimated that at least another 25% of
the actual use is smuggled into the country over non-secured borders [21, 22].
SEARCH STRATEGY
To identify relevant articles in relation to pesticide use and poisoning in developing countries, literature
researches were done from September to November 2010, looking for relevant articles in both national
and international public health databases using SveMed+, Cochrane and PubMed.
The search strategy was the same in each database using ‖advanced search‖.
The main search words being used were ―pesticide‖ and ―poisoning‖ or ―toxic‖, all of them being
truncated. This resulted in only one relevant article in SveMed+.
Searching for reviews with the same words in Cochrane gave 34 hits. Many of these reviews dealt with
treatment of poisoning with organophosphate and were irrelevant for this study. Also, a lot of them were
references to the Cochrane Injuries Group (CIG). CIG is an editorial base with the purpose of preparing,
maintaining and promoting the accessibility of systematic reviews in the prevention field, including
poisoning. Eight reviews dealt with poisoning. However, all of these also concerned treatment of
pesticide poisoning which was not relevant for this study.
PubMed had 13437 hits. To narrow this number down, different combinations were made, with the
following words: ―Developing countries‖ or ―Africa‖ or ―Uganda‖. Also ―knowledge‖, ―practice‖ and
―attitude‖ were used, both combined and divided. Furthermore, the abbreviation ―KAP‖ was also used.
―Small-scale farmers‖, ―small scale farmers‖ and ―small holders‖ were used. All words were truncated
and combined with either AND or OR, according to the relevance. Relevant abstracts from the different
hits were read through, resulting in 48 articles with the criteria of being either; a cross sectional study,
looking at self-reported incident of pesticide poisoning, located in Africa or concerned with knowledge in
relation to pesticides.
Apart from these, relevant reports from the WHO or FAO were included.
THE FRAMEWORK OF THE PROJECT
The project is a collaboration between the Danish NGO, Dialogos and the Ugandan NGO, Uganda
National Association of Community and Occupational Health (UNACOH). UNACHO wishes to
promote a healthy and productive Ugandan population, and has been involved in several Ugandan
occupational health projects. Dialogos has worked with occupational health in developing countries since
1993. It wants to assist developing countries in their self-chosen pathway away from poverty.
The present project is called ―Pesticide use, health and environment in Uganda–. Project‖ and is a three
year intervention study of farmers´ pesticide use, health and environment in Uganda running from
6
summer of 2010 -2013. The general objective of the intervention project is to reduce negative health
effects of pesticides in humans and prevent pesticide pollution of the environment.
Moreover, Dialogos are working together with ICOEPH (International Centre for Occupational and
Environmental Medicine and Public Health) on this project. ICOEPH is a centre formed by professionals
and institutions with profound knowledge and experience in the fields of occupational medicine,
environmental medicine and public health. ICOEPH and Dialogos have been working together for the
past eight years on IPM and ―Pesticides, Health and Environment‖ in Bolivia, and have gained experience
in minimising pesticide problems in most developing countries.
In Denmark, a steering committee is responsible for the technical management and guidance of the
Ugandan project. The committee consists of volunteers from Dialogos, ICOEPH and the universities.
Dialogos is responsible for managing the funds for the project and the fundraising, monitoring and
reporting of the project, while UNACHO will be responsible for implementing and the day-to-day work
of the project [22].
The presented article is the final product of a research year in collaboration with Dialogos, ICOHEP,
Bispebjerg Hospital and Copenhagen University. The research year takes basis in gathering of the
―Pesticide, Health and Environment, Uganda. Project‖ baseline and has consisted of writing a project
description (appendix 1), typing of the questionnaire (appendix 2), gathering of data, typing of data,
analysis of data and writing an article. By agreement with Copenhagen University, the article will account
as a thesis (appendix 3).
Jane Frølund (JF), who is a member of ICOEPH and connected to Copenhagen University, is the main
supervisor of this thesis. JF is located at Bispebjerg Hospital Work and Occupational Medicine
Department, where I have been seated when not in Uganda. Erik Jørs (EJ), who is the secondary
supervisor of the thesis, is located at Odense University Hospital. JF was mainly supervising before and
after the data gathering in Uganda, while EJ was supervising during data gathering in Uganda.
Deo Sekimbi (DS), who is the project coordinator in Uganda, was also present during the data gathering,
and will be responsible for the future coordination of the project in Uganda. At the same time of the
baseline gathering observational studies were done, concerning the use of pesticides and protective
measures.
7
ARTICLE
8
PESTICIDE USE AND HOW IT AFFECTS THE HEALTH OF SMALL SCALE
FARMERS IN UGANDA: A CROSS-SECTIONAL STUDY
ABSTRACT
Over the past years there has been an increase in the use of pesticides in developing countries, many of
them being listed as extremely and highly hazardous. Improper use of pesticides can cause acute pesticide
poisoning. A cross-sectional study was conducted using a standardized questionnaire. 319 small scale
farmers in the districts of Pallisa and Wakiso in Uganda were interviewed. The study showed that the
main pesticides used belonged to WHO class II pesticides, and that a majority of the farmers did not use
appropriate personal protective equipment (PPE). Also many farmers lacked adequate knowledge
concerning the colour coding of the pesticides.
There was no significant association between the number of times sprayed with pesticides and self
reported pesticide symptoms. However there was a significant association between using their mouth to
unblock the nozzle of the knapsack sprayer (OR 2,13 with a 95% CI 1,09 – 4,18) when spraying with
class II pesticides within the last year.
These findings suggest that an effort must be made to upgrade the farmers’ knowledge so that they keep
the most dangerous pesticides off the market. Additionally attention should be called to class III and U
pesticides, helping the farmers to understand the classification and labelling of the pesticides, and future
interventions also must focus on not using their mouth to unblock the nozzle.
Keywords: pesticides, poisoning, small scale farmers, health, knowledge, developing country.
9
BACKGROUND
The balance between population increase and sufficient food production is one of the most important
challenges in many African countries, including Uganda [23]. The use of pesticides is an effective method
to protect crops from being damaged and to improve yields [24]. Over the past years there has been an
increase in the use of pesticides in developing countries, and the developing countries now account for
about 20% of the worlds expenditure [25]. However, improper use of pesticides can cause direct human
poisoning, accumulate as residues in food and environment and lead to the development of resistance in
pests [26, 27].
Approximately 300.000 workers die worldwide from pesticide exposure every year with the majority of
deaths occurring in developing countries [2, 5]. The main part of these deaths is due to self-poisoning. In
addition to this comes 3.000.000 cases of acute pesticide poisoning every year [16].
The Food and Agriculture Organisation of the United Nations (FAO) has tried to control the use of
pesticides with its code of conduct [5]. For instance, FAO recommend governments in developing
countries that small scale farmers should only be given access to pesticides that require little personal
protective equipment [3, 12, 28, 29]. Moreover The World Health Organisation (WHO) has made an
Essential Drug List (EDL) categorising the pesticides according to health hazard, going from extremely
hazardous to unlikely to present acute hazards. This is a useful tool, especially for developing countries,
for elimination of the most dangerous pesticides. However, many pesticides used in developing countries
are still listed as extremely and highly hazardous [3, 12]; for example, Jors et. al. have documented a
frequent use of the most toxic pesticides among farmers in Bolivia, who have had no introduction on how
to use pesticides and protect themselves against the dangers of intoxication [13]. Also, studies in four
African countries have shown use of unauthorised pesticides and a lack of advice on alternatives [20].
It is crucial that the use of pesticides is assessed to ensure that it does not harm humans or nature.
Therefore the use of pesticides in developing countries should be further investigated and clarified, to
provide a guideline for governments and international organizations making appropriate policies [13, 24,
30].
Many farmers in Uganda are small scale farmers with less than a few acres per household. Often they
farm without the money or the knowledge to use pesticides appropriately [19]. Incorrect dosage, incorrect
timing and targeting, poorly maintained equipment, mixing with bare hands, lack of personal protective
equipment (PPE) and lack of precautions when spraying may result in acute pesticide poisoning (APP)
[20, 31, 32]. In the absence of appropriate handling with pesticides, not only the health of farmers, but
also their families´ health is at risk [23].
Studies have shown that it is beneficial to look at the knowledge, practice and attitude towards pesticide
use. Yassin et. al have made a study in the Gaza Strip pointing to the fact that even though the farmers
10
had high levels of knowledge on the health impact of pesticides they did not act according to this. It is
important to emphasize that clarifying these aspects makes it easier to take action where it is needed. This
will over time minimize the hazards of occupational pesticide exposure [23, 30, 31, 33].
The aim of this paper is to determine the extent and character of pesticide use by small scale farmers in
Uganda, and to examine the practise and impact of protective measures and the storage of pesticides.
Furthermore it assesses how the farmers’ knowledge affects the use of pesticides and analyses the
relationship and nature between use of pesticides and symptoms of acute pesticide poisoning.
11
METHOD
STUDY DESIGN
This cross-sectional study constitutes the baseline of a three year intervention study of farmers´ pesticide
use, health and environment in Uganda. The project is in collaboration with the Danish NGO Dialogos
and the Ugandan NGO Uganda National Association of Community and Occupational Health
(UNACOH) and is funded by The Danish Ministry of Foreign Affairs.
The general objective of the intervention project is to reduce negative health effects of pesticides in
humans and prevent pesticide pollution of the environment. The elements of the intervention consist of
educating farmers, extension workers and pesticide dealers in integrated pest management (IPM), and by
educating health care workers in prevention, diagnosis and treatment of acute and chronic pesticide
poisonings. Through seminars and meetings, the project aims to help local key stakeholders to form a
pesticide committee. The effect of the intervention will be assessed in 2013.
SETTING
We conducted a cross-sectional study including 317 small scale farmers. The fieldwork was carried out
from January to February 2011 in two different districts in Uganda: Wakiso and Pallisa. According to the
research from the planning of the project Wakiso primarily grows vegetables (groundnuts, tomatoes,
green pepper etc.) and Pallisa primarily produce cotton. 40-90% of the farmers were expected to use
pesticides [22].
Wakiso is situated in the northern part of Uganda, approximately 20 kilometres northwest of the capital
Kampala, close to Lake Victoria, with an average elevation of one kilometre above sea level. 1.310.100
people is living in Wakiso.
Being close to Lake Victoria the Wakiso district is generally very fertile.
Pallisa is situated in the eastern part of Uganda, 170 kilometres from Kampala close to the border of
Kenya, also with an average elevation of one kilometre above sea level, with a population of 394.000
people.
Pallisa's climate is predominantly continental with a lot more sun and less rain. Unfortunately, the study
data was gathered in Pallisa’s dry season. This affected the outcome of our analyses as the spraying is
generally more frequent in the wet season due to higher pressure of insect pests, diseases and weeds.
PARTICIPANTS
In many African countries, farming is usually a business with all the family members engaged in the
agricultural activities. Hence the whole family appears to be at risk of pesticide exposure [23]. Therefore
we accepted subjects of different ages and both genders. Having enough women in the material to make
12
statistical analysis was a priority in the gathering of the study population, since the data on women and
pesticides are currently very limited.
The project team, consisting of the project manager (EJ), the day to day project leader (DS), the research
assistant (AH) and local assistants, visited and established contact to the local authorities in the two
districts before starting the data collection. During these meetings, time and dates of the interviews were
scheduled.
In each district a mid-level manager was connected to the project team. He or she was in charge of
making contact with the local farmers and of making arrangements for interviewing. Both farmers
organized in a farmers´ group and farmers outside a group were included in the study. At most times all
members of a farmer group would gather at the group leader’s house or at a village hall. At other times
they would gather in smaller numbers at different more convenient places, like member homes or in the
field. Meetings with farmers who were not a member of a farmer group would also be arranged by the
mid-level manager, these interviews were carried out in the home or in their field.
The interviewers were dropped off at the interviewing spot in the morning, picked up for lunch and then
again going out for more interviews in the afternoon. Several places were only accessible by foot or in a
four wheel drive truck and therefore transportation was a time-consuming factor.
The total number of small scale farmers´ in the visited areas is not available. Therefore it is not possible
to calculate how big a part the 317 farmers represent or how many chose not to be part of the study.
STANDARDIZED INTERVIEWS
All participants were interviewed individually with the use of a standardized questionnaire. The
questionnaire has been used successfully in other studies in Colombia and Bolivia. It was originally
written in Spanish but translated into English [13, 34].
Most questions were one of two types; either yes/no questions, offering a dichotomous choice, or multiple
choice questions, offering several fixed alternatives. In addition to demographics and crop production, the
questionnaire asked about type and amount of pesticides used, knowledge of pesticides, attitude and
practice during the mixing, application and storage of pesticides and toxicity symptoms.
A pre-test was carried out with 15 farmers in both Pallisa and Wakiso (not included in the sample) to
modify the questionnaire. The modification primarily included rephrasing to more understandable English
and focusing on more information about the training and handling of pesticides.
At each district 8-12 people interviewed the farmers. The interviewers were young Ugandan students or
recently graduated. The people interviewing in Pallisa were not the same as in Wakiso except for the
project team which was involved in both districts.
Each question was translated on the fly by the interviewer from English into the local language during the
interview. Consequently there might have been small differences in the translation. To minimise this and
other biases there was a two day introduction to the questionnaire before starting the interviews. An
13
important part of this training was to secure that the interviewers understood the meaning of the
questions, and to discuss possible ways to translate each question from English to the local languages.
The interviewers were also instructed on when only to choose one fixed answer and when it was possible
to tick multiple answers and when to read the fixed answers aloud and when not to. An additional part of
the training was that the project team or public health and agronomist teachers at Makerere University
reviewed the first couple of responses together with each interviewer, in an effort to minimise
misunderstandings.
All interviews were conducted face to face, and a trained interviewer would take approximately 30
minutes to complete an interview.
EXPOSURE VARIABLES
Exposure to pesticides may be by inhalation of vapour or direct dermal or oral contact. The main
exposure measure covering these routes of exposure were self-reported number of times sprayed.
There were two different time points measuring this exposure. The first one was number of times sprayed
in the last month, and the second was number of times sprayed in the last season.
Pesticides used within the last month were divided into three groups: sprayed 1 time, sprayed 2-3 times
and sprayed more than 3 times. People not spraying were left out of this part of the analysis, because they
were not asked about symptoms in the last month. Pesticides used last season were divided according to
the WHO classification of pesticides, making it possible to do analysis on class II, III and U pesticides.
Moreover for class II pesticides we divided the number of times spraying into tertiles; spraying 1-7 times,
8-12 times and more than 12 times, using ´not spraying´ as the reference group. Class III and U pesticides
were divided dichotomously into not spraying or spraying one or more times.
When using a knapsack sprayer to distribute pesticides the nozzle sometimes blocks. The second
exposure variable was whether the small scale farmer would use his mouth to blow or suck in order to
unclog the nozzle. This variable was divided dichotomous (yes/no).
OUTCOME VARIABLES
The questionnaire included three self-reported outcome measures in relation to pesticide poisoning. As
the first measure each farmer was asked if he or she had had any symptoms immediately after pesticide
spraying in the last year, spontaneously mentioning all the symptoms they could recall (―spontaneous last
year‖). Secondly the farmers were asked in the same way if they had experienced any symptoms
immediately after spraying pesticides within the last month (―spontaneous last month‖). Finally, as the
third measure, the farmers were once again asked if he or she had had any symptoms the last month, but
now 18 different symptoms were read aloud, allowing for the farmer to agree or disagree with each
symptom (―asked the last month‖). The reason for making both a ―spontaneous‖ and an ―asked‖ outcome
measure was to eliminate possible recall bias that could happen in a cross-sectional study.
14
Each symptom was aggregated into a dichotomous variable, with 0-1 symptom coded as 0 and more than
one symptom coded as 1. This was a choice made because many of the symptoms spontaneous and asked
are frequent in other diseases. For all three outcome measures only symptoms potentially related to class
II and III pesticides were included [35].
POTENTIAL CONFOUNDERS
The following set of explanatory and potential confounder variables were included in all analyses:
District (Wakiso/ Pallisa), age (continuous), gender (female/male), marital status (yes/no), farmer group
(yes/no), educational level (no education/ primary school/>primary school), PPE (yes/no) and precautions
(1-2/>2). Age was used as a continuous variable. We used both age and age squared in the analyses.
One might argue that it would have been better not to keep all the potential confounders in the analyses,
but these factors have previously shown to have an effect on pesticide symptoms and were therefore kept
in the analyses [13, 33, 36].
STATISTICAL METHOD
Descriptive statistics with means, standard deviation (SD) and range were used. The association between
exposure (number of times sprayed in previous month / season) and health outcome were analyzed using
logistic regression. Both crude and adjusted odds ratios are presented. The adjusted logistic regression
analyses included district, age and age squared, gender, marital status, farmers group, educational level,
PPE and precautions.
Sensitivity analyses were performed with different cut points for number of times sprayed with pesticides
and number of symptoms.
Earlier analyses have shown an association between gender and number of times spraying with pesticides
[37]. Therefore interactions were calculated for gender, with both the type of interaction and the main
effects in the analyses. Also there might be an association between the exposure variable and age so
interactions were also calculated for this variable [38]. As differences in the two districts turned out to be
significant, analyses with stratification was also carried out.
MISSING DATA
Because data was gathered by interviews, missing variables were kept to a minimum, less than 3% on
average. In the few cases of missing values, most of these are related to interviewers being unable to
translate the question, respondents not understanding the question or typing errors.
15
ETHICAL CONSIDERATIONS
The Helsinki declaration of ethical principles for medical research were followed [39]. The study was
approved by the local leaders in each district, before starting the data collection. It was voluntary to
participate in the study and the participants were encouraged, but not forced, to be part of the interview.
All respondents were explained the purpose of the study, and after informed oral consent, written consent
was obtained from each participant. Illiterates provided a thumb print as an indication of their consent.
16
RESULTS
PARTICIPANTS
The total number of responses was 317. Tables 1 and 2 provide demographic details of the participants.
The majority of the farmers were males (61%), a total of 155 (49%) were from Wakiso and 161 (51%)
were from Pallisa. The average age was 42 years, and 216 (68%) of the farmers were organised in farmers
groups.
Analysis of the educational level showed that 42 (13%) had no education, 143 (45%) had finished
primary school and 116 (37%) had an education level of secondary school or above. The range of land
used for crops was from 0,25 – 38 acres. This measure is self reported, and may be quite imprecise since
many of the farmers were unsure of how much an acre was. However, with a mean of 4,15 acre, the
presumption that most farms are small scale is being confirmed.
CROPS
Figure 1 shows the crops grown in the two districts, on which the farmers use pesticides. The Figure
illustrates that different crops are grown in the two districts. In Wakiso there is a greater diversity of what
is being grown. The main crops grown in Wakiso are tomatoes, nakati (a kind of eggplant), cabbage and
green pepper. In Pallisa the main crops are cotton, green peas and cowpeas. The figure also shows that
many of the farmers grow more than one crop.
PESTICIDES
A total of 306 (96%) interviewed farmers were using pesticides and had been doing so with a mean
average of 17,5 years.
The 14 self-reported pesticides used by the farmers in the last month are shown according to the WHO
classification, and chemical family in Table 3.
No pesticides were registered as extremely hazardous (Ia) or highly hazardous (Ib). Moderately hazardous
(class II) were the most frequently used pesticides according to the questionnaire with cypermethrin and
cypermethrin-profenofos being used by the largest number of farmers. To some degree slightly hazardous
pesticides (class III) and pesticides unlikely to present any harm in normal use (class U) were used,
mainly Glyphosphate and Mancozeb [12]. Figure 2 shows the number of times the farmers sprayed with
the different pesticides within the last season in Wakiso and Pallisa. Unfortunately it is not possible to say
anything about the amount of pesticides used when spraying. However it is possible to say that pesticides
were sprayed more often in Pallisa than Wakiso in the last season.
17
SYMPTOMS
The prevalence of self-reported symptoms is shown in Figure 3. The symptoms shown are divided into
the three outcome categories: Symptoms immediately after spraying in the last year (―spontaneous last
year‖), symptoms immediately after spraying in the last month (―spontaneous last month‖) and symptoms
immediately after spraying in the last month (―asked last month‖). Skin irritation, headache, extreme
tiredness, blurred vision and dizziness are the most commonly reported symptoms. The table shows - not
surprisingly - a tendency to more symptoms being reported in the last year and when asked.
KNOWLEDGE
Levels of knowledge among the farmers are described in Table 4. 289 (92%) of the farmers think
pesticides can have a negative effect on their health, 276 (90%) know that the pesticide containers have
marks showing the toxicity and 228 (74%) say that they are able to read and understand these
instructions. Despite these facts only 69 (22%) know that red color indicates the most dangerous
pesticides. Even more farmers (64%) do not know which sign marks the least dangerous pesticides.
Approximately one third (31%) of the farmers have had training on how to use and handle pesticides.
PRACTICE AND ATTITUDE
Table 5 illustrates the practice and attitude for small scale farmers towards pesticides.
The majority of the farmers (93%) use a knapsack sprayer to distribute and mix the pesticides. More than
80% of the small scale farmers take less than 3 hours to spray their field. 22% of the males and 12% of
the females take more than three hours to spray their field.
Questions relating to personal protective equipment and precautions after using pesticides show that a
high percentage (73%) use ordinary clothing when spraying. The most commonly used PPE were boots
(51%), followed by long-sleeved t-shirts (24%). Most of the farmers take precautions after spraying
pesticides, but only 80 (26%) take precautions after mixing pesticides. More than one third of the farmers
(39%) mixed several pesticides in one mixture. A total of 170 (56%) farmers stored the pesticides inside
the house, 39 (13%) stored them outside the house, 72 (23%) in a storehouse and 17 (5%) stored them in
the field.
ASSOCIATION BETWEEN SYMPTOMS AND PESTICIDE USAGE
To clarify the association between self-reported symptoms and pesticide usage, logistic regression
analyses were conducted. Table 6 lists the association between spontaneously reported and asked
symptoms the previous month and number of times sprayed with a pesticide the last month. The analyses
were conducted on 171 of the 309 participants (62 from Pallisa and 109 from Wakiso). The crude odds
ratios showed no significant association between numbers of times sprayed and symptoms of pesticide
18
poisoning. There was an increased crude OR of 2,45 (95% CI of 1,12 - 5,36) for spontaneously selfreported pesticide symptoms in Pallisa. After adjusting for potential confounders there was still no
association between the number of times sprayed and self-reported pesticide symptoms, and the potential
confounder district became non-significant.
Precautions (continuous) showed a significant association with an OR of 1,46 (95% CI 1,02-2,09) for
asked symptoms in the last month.
Table 7 shows the association between symptoms immediately after spraying the last year for class II,
class III and class U pesticides. These analyses include the whole population of 317 participants. The
analyses show that there is no significant association between self-reported symptoms and the amount of
times sprayed with each pesticide class. However, the results show that district is a potential confounder
with and an increased OR of 2,56 for Pallisa (95% CI 1,34 – 5,24) when spraying with class II pesticides.
The same tendencies are shown for class III and U pesticides, decreasing when using less dangerous
pesticides.
Gender and farmers group were shown also to have a significant association as confounders, increasing
the risk of pesticide poisoning if you are in a farmers´ group (class II: OR = 2,22, 95% CI = 1,18 – 4,19)
(class III: OR 2,17, 95%. CI 1,16 – 4,08) (class U: OR 2,17, 95% CI 1,15 – 4,06 ) and decreasing the
risk when being a woman (class II: OR 0,49, 95% CI = 0,26 – 0,92; class III: OR 0,49. 95% CI 0,26 –
0,89; class U: OR 0,49. 95% CI = 0,27 – 0,90).
Again the analysis show that those taking more precautions (continuous) have a significantly higher risk
of more than 1 symptom with an 95% OR of 1,32 and a CI 1,02 – 1,79 for class II pesticides (class III:
OR 1,34, 95% CI 1,03 – 1,75; class U: OR 1,36, 95% CI 1,04 – 1,78) than those not taking
precautions.
Since several of the previous analyses showed that there was a significant difference between the two
districts we decided to make logistic regression analyses stratified on the two districts for class II
pesticides (Table 8). However, this did not change the association between the number of times sprayed
and symptoms or the unexpected directions of the ORs in some of the confounder variables. Again, a
significant protective effect was shown for females (OR = 0,34, 95% CI = 0,13 – 0,84) and an increased
risk when taking precautions (OR = 1,75, 95% CI = 1,17 – 2,63) for Pallisa. Significant associations were
found for spraying 1-7 times (OR= 0,17, 95% CI = 0,03 – 0,99) compared to not spraying and farmers
group (OR = 3,6, 95% CI = 1,23 – 10,45) was found in Wakiso.
When testing for interaction there were no significant findings. Also when changing the cut points for
number of times sprayed and number of symptoms this did not influence the odds ratios significantly. As
well as age squared did not have any significant effect on the outcome.
19
SUPPLEMENTARY ANALYSES
To look at the symptoms in another perspective we divided them into four categories: Neurological
symptoms, abdominal symptoms, skin symptoms and respiration symptoms. Doing the analysis again for
each symptom group controlling for the confounders none of the groups had significant values, neither in
the last month or in the last year. Also we did not find any significant values when we examined the two
most reported pesticide poisoning symptoms, skin irritation and headache, one at a time.
Analysis performed with use of mouth to unblock the nozzle (either blowing or sucking) as the exposure
variable showing a significantly higher risk of getting acute pesticide poisoning within the last year with a
crude OR of 2,46 (95% CI 1,36 -4,33). After adjusting for the potential confounders keeping number of
times sprayed in the analysis the OR for class II pesticides was 2,13 with a 95% CI 1,09 – 4,18. When
calculation the adjusted OR the last month spontaneous and asked it is still elevated being 1,32 (0,45 –
3,88) and 1,56 (0,53 – 4,55) respectively, but not significant.
20
DISCUSSION
Our findings show that class II pesticides, mainly cypermethrin and cypermethrin-profenofos, are the
most frequently used pesticides for small scale farmers in Wakiso and Pallisa, Uganda.
This is an important finding, as other studies have shown extended use of class I pesticides in developing
countries. In a cross sectional study by Jors et al. in Bolivia for small scale farmers, it was shown that one
of the frequently used pesticides is Methamidophos, which is classified as highly hazardous class Ib [13].
Also in Vietnam there has been an increased use of class I pesticides even though many of them are
banned [40]. However a study made by Ngowi et. al. in Northern Tanzania, close to the border of
Uganda, has shown a low quantity of class I pesticides; also a study made in Ghana indicates that small
scale farmers
mainly used class II and III pesticides [26, 36]. These studies suggest that African small scale farmers are
not as exposed to class I pesticides as Asian and Latin American farmers. A study made in Kenya found
that mainly large scale farmers and not small scale farmers used class I pesticides [41].
Nevertheless class II pesticides are still known to have a moderate hazardous effect on humans, and there
are other less dangerous alternatives [12, 29]. In addition, we expected that 40-90 % of the farmers used
pesticides, but the data showed that 97% did. This supports the fact that the use of pesticides is increasing
in Africa, and will probably continue to do so as long as the population increases. Effective interventions
needs to be introduced to help the farmers get a sustainable relationship to pesticides [19]. Another focus
of this study was to examine the practice and impact of protective measures and the storage of pesticides.
Less than one of six uses any of the four protective measures: Gloves, overalls, masks or hats. And more
than half of the farmers store pesticides inside their house. This puts the environment and the health of the
farmer and his family at risk [19, 20, 23, 26]
Moreover many of the farmers in Pallisa and Wakiso do not know enough about how to use and handle
pesticides. As seen in other studies the small scale farmers have some knowledge of the names and
effects of the pesticides they use but lack knowledge about mixing and of the color coding of pesticides
[13, 23, 33]. These findings show lacking knowledge, and unhealthy practices and attitudes concerning
the use of pesticides. Without adequate knowledge, practice and attitude on pesticide classification
systems, application rates, inefficiency of combining pesticides, re-entry periods, mixing and storage of
pesticides farmers are unable to make good crop decisions and exercise proper practices [2, 26].
Integrated Pest Management has shown to have an effect on minimizing the use and improper practice of
pesticides. IPM emphasizes the importance of the growth of healthy crops and encourages natural pest
controls systems. It keeps the use of pesticides to a level that is affordable for the farmers and reduces the
risk to humans and the environment while still yielding the expected outcome [20, 29, 30, 42].
This study also hypothesized that there would be an association between use of pesticides and pesticide
poisoning symptoms. The result of the comparison does not support this hypothesis. After adjusting for
21
gender, age, marital status, member of a farmers group, district, PPE and precautions, the OR did not
show a significant association between number of times sprayed and symptoms of acute pesticide
poisoning.
The lack of associations between number of times sprayed and pesticide poisoning symptoms could be
due to numerous reasons.
Firstly confirming an association in a cross sectional design can easily lead to overestimation of the
assumption between outcome and exposure, because of recall bias [43]. In the present study we made an
effort to avoid this by making numerous outcome measures. First of all the farmers were asked to mention
symptoms both within the last year and the last month, because we assumed that the last month would be
less sensible of recall bias hence making it the strongest association between number of times sprayed and
APP. However, because of the dry season in Pallisa, symptoms within the last year turned out to be the
most reliable measure.
Secondly we assumed that we could remove some reporting bias by having the farmers spontaneously
mention symptoms in relation to pesticides, and then afterwards asking about specific symptoms both
related and un-related to pesticide poisoning. However we did not encounter this kind of bias. The main
symptoms reported were skin irritation, headache, extreme tiredness, blurred vision and dizziness which
are consistent with other studies [44]. Many of these symptoms could be due to other factors like hot
climate, long exposure to sunlight or other diseases [26]. This might also affect the outcome as the farmer
might be exposed to these factors simultaneously. We could have eliminated some of this by focusing
more on physical signs, making health care personal observe the farmers. Another possible way to obtain
better information in relation to symptoms could be to ask the farmer to keep a diary and write down
symptoms occurring up to 48 hours after spraying; this could eliminate some recall bias [10]. S. Dasgupta
et al. calls attention to the point that self-reported symptoms is a weak indicator for pesticide poisoning,
and recommend AChE testing instead [40]. However AChE can be insufficient as there is a big variation
within people and would make the study much more costly [15].
It is also possible that the amount of pesticide sprayed was insufficient for an exposure to be detected,
supported by the fact that majority of the farmers took less than three hours to spray their field and only
used class II pesticides.
Thirdly conduction of the interviews might have had an influence on the missing association between
number of times spraying pesticides and pesticide poisoning symptoms. Even though interviews were
carried out by trained groups, and the training emphasized understanding the questionnaire, it was not
possible to ensure that the translation of the questionnaire was clear and understandable, as we couldn’t
fully control the translation. With up to 14 people doing the interviews it is almost impossible to secure
stringency and homogeneity. By a written translation of the questionnaire into the local language we
might have been able to eliminate some interview bias. Also the study population itself could encounter
some bias as we didn´t know the overall number of farmers in the two districts. However it seemed like
the farmers gladly participated and that they were representative of the general population in the two
22
districts and all the farmers who had the opportunity to participate did so. The only farmers not
participating were the ones who did not know about the study.
We did find a constant increased risk of getting pesticide poisoning when living in Pallisa (OR 2,7) when
using class II pesticides in the last year. When stratifying in the two districts there was still no association
between number of times sprayed and pesticide poisoning symptoms. The reason for the increased risk
could be that the main crop grown in Pallisa is cotton, which is a high growing vegetable, and thereby the
pesticides are closer to the breathing zone posing more danger. Another reason could be that Pallisa is a
more remote area, not having the same access to knowledge as Wakiso.
Also male farmers seemed to have an increased risk of getting pesticide poisoning. There has been
expressed concern about female farmers spraying and the need for more data [38, 45]. Therefore it was a
priority in this study to interview both males and females farmers. However when it comes to spraying of
pesticides, the knapsack sprayer (which was used by 93% of the farmers) is very heavy. Other studies
have shown that it is mostly men carrying the knapsack sprayer, where women are more involved in
transporting, weeding and harvesting [36]. If men carry the knapsack sprayer for a longer time than
women, men will have a longer exposure time. This is consistent with the fact that 22% of the men, and
only 12% of the women, carry the knapsack sprayer for more than three hours in this study, and could be
one of the reasons for the elevated OR for men [46]. Very few studies look at both genders in relation to
pesticide exposure. The number of women participating in this study is a strengthening, and may help
clarify women’s exposure to pesticides, but more studies would help to clarify this relationship.
We found that farmers organized in groups had an increased risk of reporting pesticide poisoning
symptoms. We were aware of these associations, since the purpose of the groups is to strengthen its
members. This finding could also be caused by group members influencing each other in a negative way.
The group seems to be of significant importance to the farmers when it comes to distribution and selling
of pesticides, and must therefore be taken into consideration when doing interventions. There is a lack of
studies looking at how the organization of farmers in groups affects the correlation between the use of
pesticides and pesticide poisoning. It would therefore be recommended that other studies take this into
account.
Furthermore we looked at the exposure of blowing or sucking a clogged nozzle of the knapsack sprayer.
This analysis showed a significant increased risk of reporting pesticide poisoning symptoms within the
last year, controlling for potential confounders. These results suggest that this routine performed by one
fifth of the farmers should be targeted in the intervention. In the study referred to earlier by Jors et. al.
49% of the farmers would either blow or suck the nozzle of the knapsack sprayer if it clogged, but the
study does not examine the association between this practice and pesticide poisoning symptoms [13].
23
CONCLUSION
As this study is a baseline in a three year intervention program, the present findings makes it possible to
specify the coming interventions where it is really needed. The study shows that the pesticides used in
Uganda are far and foremost class II pesticides and that the most dangerous pesticides are rarely found in
the market. It also shows that many of the farmers do not use the proper PPE. Moreover an effort to
upgrade the farmers’ knowledge about labelling and classification of pesticides must be made, enabling
them to stay away from the most dangerous pesticides and raising awareness of class III and U pesticides.
No association between the number of times sprayed with pesticides and symptoms of acute pesticide
poisoning was found. We found that farmers using their mouth to unblock their nozzle have an increased
risk of pesticide poisoning, making this parameter important in an intervention.
24
TABLES FOR PESTICIDE USE BY UGANDAN SMALL SCALE FARMERS:
A CROSS SECTIONAL STUDY.
TABLE 1
Distribution on district, gender, farmers group, educational level and pesticide use of small scale farmers
in Uganda.
Wakiso
District:
N
%
Pallisa
N
%
%
N
Wakiso
155
49
Pallisa
161
51
Female
123
39
64
43
58
36
Male
190
61
87
57
102
64
Yes
216
68
101
66
113
70
No
101
32
53
34
48
30
42
13
16
10
26
16
Primary School
143
45
76
49
66
41
Secondary school
112
36
54
35
57
36
4
1
4
3
0
0
Other tertiary
16
5
4
3
12
7
No
11
3
9
6
1
1
Yes
306
97
145
94
160
99
Gender:
Farmers´ group*:
Educational level:
No education
University
Use of pesticides
* Farmers´ groups are characterized by 10 – 30 farmers organizing to help each other with transportation and selling of crops to save money on
distribution expenditures, but also with the purpose of exchanging knowledge on farming.
25
TABLE 2
Demographic details (self-reported) on small scale farmers working with pesticides, Wakiso and Pallisa,
Uganda.
n
Mean
Standard Deviation
Range
Age
318
42
12,74
13 – 76 years
Acres of land cultivated
316
4,15
4,54
0,25 – 38 acres
Acres of rented land for small scale farmers
316
1,35
1,80
0 – 12 acres
Years of engagement in agriculture
316
22,46
13,28
0 – 69 acres
Years of utilizing pesticides
311
17,55
12,51
0 – 69 yeas
26
ba
na
na
be
a
ca ns
bb
ag
ca e
ss
av
a
co
t
t
co o
w n
gr pe
ou as
n
gr dnu
ee ts
n
pe
as
m
aiz
e
m
ille
t
na
ka
or ti
a
po n ge
ta
to
es
so sal
ya ad
be
an
sw
s
ee spin
t p ac
ot h
at
oe
s
to
m
a
ch to
ill
e ies
gr ggp
ee
n lant
pe
pp
er
number of farmers
FIGURE 1
Crops, on which the small scale farmers use pesticides, grown in Wakiso and Pallisa. Only crops reported
by five or more farmers are included.
160
140
Pallisa
120
Wakiso
100
80
60
40
20
0
27
TABLE 3
Classification of pesticides used by small scale farmers, in Wakiso and Pallisa, Uganda. January 2011
Pesticide
Number of farmers Pallisa Wakiso Toxicological class by WHO Chemical class
Glyphosate
14
1
13
III
Phosphonomethyl
2,4 D
2
0
2
II
Phenoxy-carboxylic-acid
Paraquat
2
0
2
II
Bipyridylium
Cypermethrin-profenofos
47
13
34
II
Pyrethroid
Cypermethrin
52
24
28
II
Pyrethroid
Endosulfan
1
0
1
II
Organochlorine
Dimethoate
16
6
10
II
Organophosphate
Malathion
1
1
0
III
Organophosphate
Fenvalerate
1
1
0
II
Pyrethroid
Alpha-cypermethrin
1
0
1
II
Pyrethroid
Mancozeb
19
2
17
U
Dithiocarbamate
Lamda cyhalothrin
11
6
5
II
Pyrethroid
DDT
1
1
0
II
Organochlorine
Dimethylcyclopropanecarboxylic
1
1
0
II
Unclassified
Unknown
28
8
20
28
ho
sa
te
pe
rm
Cy
2,
Pa 4 D
ra
qu
et
A
hr
m at
et
in
-p
r
ro yne
fe
n
Cy
pe ofo
rm s
et
Di hrin
ch
lo
En rvo
do s
Di sulf
m
a
et n
ho
M ate
al
at
Al
ph Fe n hion
va
ale
cy
pe ra t
rm e
et
h
M ri n
an
co
La
ze
m
Bu b
da
ta
cy
Di
ha nil
m
l
ot
et
h
hy
Py rin
lcy
r
clo
et
hr
pr
oi
op
d
an
ec
a r DD
bo
T
xy
lic
Un
kn
ow
n
Gl
yp
Number of times sprayed
FIGURE 2
Pesticide use from January 2011, previous season.
250
Pallisa
200
Wakiso
150
100
50
0
29
FIGURE 3
Symptoms relevant for class II and III pestecides. January 2011 and january 2010 – january 2011.
Spontaneous symptoms January 2011.
90
Asked symptoms january 2011.
80
Spontaneous symptoms January 2010 2011.
70
50
40
30
20
10
n
Di
zz
in
es
s
Sa
liv
at
io
Sk
n
in
irr
M
i
ta
us
ti o
cu
n
la
rw
ea
kn
es
s
Re
H
ea
sp
ira
da
to
ch
ry
e
di
f fi
cu
Ex
lti
tr
es
em
e
tir
ed
ne
ss
Vo
m
iti
Ab
ng
do
m
in
al
pa
Lo
in
ss
of
ap
La
pe
ck
tit
of
e
co
or
di
Ex
na
ce
tio
ss
n
ive
sw
ea
tin
g
vis
io
ed
ur
r
Na
us
ea
0
Bl
Number of farmers
60
30
TABLE 4
Knowledge on pesticide handling and toxicity.
All
Wakiso
Pallisa
n
%
n
%
N
%
No
213
69
97
67
114
71
Yes
96
31
50
34
60
29
No
183
58
90
59
92
57
Yes
132
42
63
41
68
43
No
7
2
1
1
6
4
Yes
289
92
144
95
143
89
don’t know
18
6
6
4
12
12
No
70
23
27
18
43
27
Yes
228
74
114
78
113
71
No
16
5
9
6
7
4
Yes
Have you ever had any training on how to use and handle pesticides
Do you know of any alternatives to pesticides?
Do you think pesticides can have a negative effect on your health?
Can you read and understand instructions on the pesticide containers?
Do the pesticide containers have any signs marking their toxicity
276
90
136
93
139
87
Sometimes
3
1
1
1
1
1
Don’t know
12
4
12
8
122
40
47
30
Which sign marks the most dangerous pesticide?
I don’t know
75
51
Blue color coding
5
2
0
0
5
3
Red color coding
69
22
23
16
46
29
Yellow color coding
23
8
5
3
18
11
Green color coding
7
2
3
2
4
3
Skull and bones pictorials
75
24
42
29
31
20
The smell indicates the danger
70
23
22
15
48
30
196
64
115
78
80
51
6
2
1
1
4
3
Red color coding
9
3
3
2
6
4
Yellow color coding
13
4
9
6
4
3
Green color coding
32
10
6
4
26
16
Skull and bones pictorials
8
3
4
3
4
3
The smell indicates the danger
50
16
11
7
39
25
Which sign marks the least dangerous pesticides?
I don’t know
Blue color coding
31
TABLE 5
Safety practice and attitude during pesticide mixing and application.
All
Wakiso (0)
Pallisa (1)
N
%
n
%
n
%
Ordinary clothing
229
73
105
70
123
77
Gloves
38
12
24
16
14
9
What do you wear doing pesticide spraying (PPE):
Overall
26
8
14
9
12
8
Boots
160
51
109
73
49
31
Mask
39
13
34
23
5
3
Hat
26
8
19
13
7
4
Long-sleeved shirt
76
24
35
23
41
26
Yes
304
98
145
97
157
99
No
6
2
4
3
2
1
Wash hands immediately after mixing
80
26
34
24
46
29
Wash hands immediately after spraying
188
62
113
78
74
47
Wash hands before eating in the field
34
11
21
15
13
8
11
4
3
2
8
5
240
79
95
66
143
92
215
71
110
76
103
66
< 1 hour
93
30
23
16
70
44
1-3 hour
153
50
76
52
76
48
> 3 hours
58
19
46
31
11
7
Unknown
2
1
1
1
1
1
Hours
51
17
31
21
19
12
Days
158
51
79
53
78
49
Weeks
100
32
38
26
62
39
Yes
287
93
131
89
154
96
No
21
7
15
11
6
4
Use mouth to blow to unblock
61
20
26
18
35
23
Use a sharp object to unblock
160
53
92
64
66
42
Replace with another nozzle and take to
74
25
22
15
52
33
4
1
0
0
4
3
Outside the house
138
53
42
33
95
72
In the field
111
42
73
57
38
29
Beside a water source
39
15
29
22
10
8
Do you take precautions immediately after handling pesticides?
Which ones?
when spraying
Wash hands before smoking when
spraying pesticides
Wash whole body immediately after
spraying pesticides
Shift clothes after spraying
How long does it take you to spray the field
How long does it take you to return to the same field after spraying?
Do you use a knapsack sprayer:
In case you get a blockage of your sprayer nozzle what do you do?
technician for repair
Where do you mix your pesticides:
In the house
32
Do you mix several different pesticides in one mixture?
No
187
61
47
32
140
89
Yes
121
39
101
68
18
11
Inside the house
170
56
79
53
91
57
Outside the house
39
13
20
13
19
12
Storehouse
72
23
39
26
3
19
Locked up
97
34
19
13
14
9
Free access
4
1
1
1
3
2
Hidden in the field
17
5
16
11
1
1
Box for pesticides
34
11
4
3
30
19
Where do you store your pesticides?
33
TABLE 6
Association between self reported pesticide poisoning symptoms and pesticide spraying in Wakiso and
Pallisa, Uganda. January 2011 (n= 173).
Symptoms immediately after spraying. January 2011.
Symptoms immediately after spraying. January 2011.
Spontaneous by the farmer.
Asked by the interviewer.
Crude
n
Adjusted *
OR
CI
OR
Crude
CI
Adjusted *
OR
CI
OR
CI
Number of times sprayed the last month
1 time
53
1,00
2-3 times
67
0,56
0,23 - 1,36
0,43 0,14 - 1,34
0,74 0,34 - 1,63
0,76 0,29 - 2,00
53
0,52
> 3 times
Continuous
-
1,00
-
1,00
-
1,00
-
0,20 - 1,37
0,57 0,20 - 1,59
0,81 0,35 - 1,87
0,70 0,28 - 1,78
173
0,95 0,82 - 1,09
0,95 0,82 - 1,10
1,00
0,98 0,91 - 1,06
109
1,00
1,00
1,00
0,95 - 1,06
District
Wakiso = 0,
Pallisa = 1
-
-
-
1,00
-
62
2,45
1,12 - 5,36
1,79 0,69 - 4,69
1,31 0,66 - 2,61
1,31 0,55 - 3,10
Age continuous
173
0,99
0,96 - 1,02
0,98 0,94 - 1,02
0,98
0,96 - 1,01
0,99 0,96 - 1,02
Gender
173
Male =1
109
1,00
1,00
1,00
-
1,00
62
0,74
No = 0
38
1,00
-
Yes = 1
135
3,43
0,99 - 11,94
No = 0
46
1,00
-
Yes = 1
127
Female = 2
0,33 - 1,68
-
-
0,67 0,25 - 1,77
0,72 0,36 - 1,40
0,75 0,34 - 1,66
1,00
1,00
1,00
Marital status
-
-
-
3,20 0,82 - 12,52
0,93 0,43 - 2,03
0,99 0,40 - 2,44
1,00
1,00
1,00
Farmers group
-
-
-
0,95 0,40 - 2,24
0,98 0,37 - 2,63
0,68 0,32 - 1,44
0,69 0,29 - 1,61
1,00
1,00
1,00
Education level
No education
22
1,00
Primary school
80
1,63
0,43 - 6,22
-
1,51 0,36 - 6,32
-
0,53 0,18 - 1,61
-
0,47 0,15 - 1,50
-
More then primary
71
1,58
0,41 - 6,12
1,36 0,31 - 5,99
0,60 0,20 - 1,83
0,60 0,17 - 2,07
1,00
PPE
0 PPE
43
1,00
1,00
-
1,00
> = 1 PPE
130
1,03
0,43 - 2,50
-
1,27 0,43 - 1,27
-
0,81
0,38 - 1,74
0,95 0,39 - 2,33
-
Continuous
173
0,99
0,77 - 1,27
1,15 0,85 - 1,56
0,92 0,75 - 1,13
0,92 0,71 - 1,81
1,00
1,00
1,00
Precautions after using pesticides
1-2 precautions
85
1,00
> 2 precautions
84
0,53
0,43 - 2,50
0,56 0,23 - 1,37
1,34 0,70 - 2,59
1,87 0,88 - 3,94
169
0,90
0,64 - 1,27
0,96 0,66 - 1,40
1,25
1,46 1,03 - 2,09
Continuous
-
-
-
0,93 - 1,67
-
*The adjusted analyses include the following potential confounders: district, age gender, farmer group, education level, use of PPE and
precautions.
34
TABLE 7
Associations between self reported pesticide poisoning symptoms and pesticide spraying January 2010 2011. Class II, III and U pesticides. Wakiso and Pallisa, Uganda (n=317)
Symptoms immediately after
Symptoms immediately after spraying.
Symptoms immediately after spraying.
spraying. January 2010 -11. Previous
January 2010 -11. Previous year.
January 2010 -11.
year
Crude
n
OR CI
Adjusted*
Crude
OR
n
CI
OR
CI
Adjusted*
Crude
OR
n
CI
Adjusted*
OR
CI
OR
CI
Number of times sprayed with
Number of times sprayed with class 2 pesticides.
Number of times sprayed with class 3 pesticides.
Didn’t spray
51 1,0
1-7 times
52 0,9 0,3 - 2,3
0,5 0,2 - 1,6
> 1 time
8-12 times
113 1,5 0,7 - 0,3
0,6 0,2 - 1,6
Continuous
> 12 times
103 1,7 0,8 - 3,8
0,9 0,3 - 2,2
Continuous
317 1,0 0,9 - 1,0
1,0 0,9 - 1,0
-
1,0
-
District
Didn´t spray
290 1,0
-
1,0
class U pesticides.
-
265 1,0
-
1,0
-
29 0,6 0,2 - 1,5
0,5 0,2 - 1,5
54 0,7 0,4 - 1,4
0,7 0,3 - 1,7
317 0,9 0,7 - 1,0
0,7 0,5 - 1,1
317 1,0 0,9 - 1,0
1,0 0,9 - 1,0
1,0
155 1,0
1,0
District
Wakiso
155 1,0
Wakiso
155 1,0
Pallisa
161 2,3 1,4 - 3,9
-
2,7 1,3 - 5,2
Pallisa
161 2,3 1,4 - 3,9
2,3 1,2 - 4,4
161 2,3 1,4 - 3,9
2,2 1,1 - 4,3
Age
317
1,0 0,9 - 1,0
Age
317
1,0 0,9 - 1,0
1,0 0,9 - 0,9
1,0 0,9 - 1,0
1,0 0,9 -0,9
1,0
-
Gender
190 1,0
Female = 2
123 0,5 0,3 - 0,9
-
1,0
-
0,5 0,3- 0,9
Marital status
Yes = 1
-
-
Male
190 1,0
Female
123 0,5 0,3 - 0,9
-
1,0
-
0,5 0,3 - 0,9
190 1,0
-
123 0,5 0,3 - 0,9
1,0
-
0,5 0,2 - 0,9
Marital status
55 1,0
-
262 2,0 0,9 - 4,1
1,0
-
No
1,3 0,6 - 2,6
Yes
Farmers group
55 1,0
-
1,0
-
55 1,0
-
1,0
-
262 2,0 0,9 - 4,1
1,3 0,6 - 3,3
262 2,0 0,9 - 4,1
1,4 0,6- 4,1
1,0
101 1,0
1,0
Farmers group
No = 0
101 1,0
Yes = 1
216 1,8 1,0 - 3,1
-
1,0
-
No
101 1,0
2,2 1,2 - 4,2
Yes
216 1,8 1,0 - 3,1
Education level
No education
1,0 0,9 - 0,9
-
Gender
Male = 1
No = 0
-
-
-
2,2 1,2 - 4,1
-
216 1,8 1,0 - 3,1
-
2,2 1,2 - 4,1
Education level
42 1,0
-
1,0
-
No education
42 1,0
-
1,0
-
42 1,0
-
1,0
-
Primary school
134 2,2 0,9 - 5,2
2,0 0,8 - 5,0
Primary sc.
134 2,2 0,9 - 5,2
2,1 0,8 - 5,0
134 2,2 0,9 - 5,2
2,1 0,9 - 5,2
> primary
132 1,6 0,7 - 3,8
1,2 0,5 - 3,2
> primary
132 1,6 0,7 - 3,8
1,3 0,5 - 3,2
132 1,6 0,7 - 3,8
1,3 0,5 - 3,2
0 PPE
102 1,0
1,0
0 PPE
102 1,0
1,0
102 1,0
1,0
> 1 PPE
209 1,1 0,6 - 1,8
1,3 0,7 - 2,5
> 1 PPE
209 1,1 0,6 - 1,8
1,3 0,7 - 2,4
209 1,1 0,6 - 1,8
1,3 0,7 - 2,4
Continuous
311
1,1 0,9 - 1,3
Continuous
311
1,1 0,9 - 1,3
1,0 0,8 - 1,2
1,0 0,8 - 1,3
PPE
PPE
-
1,0 0,8 - 1,2
-
Precautions after using pesticides
-
-
1,0 0,8 - 1,2
-
-
-
Precautions after using pesticides
1-2 prec.
140 1,0
1-2 prec.
140 1,0
>2 prec.
162 1,3 0,8 - 2,2
1,5 0,9 - 2,7
> 2 prec.
162 1,3 0,8 - 2,2
1,6 0,9 - 2,7
162 1,3 0,8 - 2,2
1,6 0,9 - 2,7
Continuous
302
1,3 1,0 - 1,8
Continuous
302 1,2 0,9 - 1,6
1,3 1,0 - 1,8
1,2 0,9 - 1,6
1,4 1,0 - 1,8
1,2 1,0 - 1,6
1,0
-
-
1,0
-
140 1,0
-
1,0
* The adjusted analyses include the following potential confounders: district, age gender, farmer group, education level, use of PPE and
precautions.
35
-
TABLE 8
Association between self reported pesticide symptoms and pesticide spraying January 2010-11. Divided
in the two districts Wakiso and Pallisa, Uganda (n=317).
Pallisa
Wakiso
Symptoms immediately after spraying.
Symptoms immediately after spraying.
January 2010 - 2011.
January 2010 - 2011.
Crude
n
Adjusted *
OR
CI
Crude
OR
CI
Number of times sprayed with class 2 pesticides.
Didn´t spray
n
Adjusted *
OR
CI
OR
CI
Number of times sprayed with class 2 pesticides.
9
1,00
-
1,00
1-7 times
19
3,15
0,52 - 19,27
2,71
8-12 times
81
1,95
0,38 - 10,02
0,90
> 12 times
52
2,19
0,41 - 11,60
0,84
Continuous
152
0,99
0,95 - 1,03
0,96
Age
161
1,00
0,97 - 1,02
0,98
102
1,00
58
0,46
No
14
1,00
Yes
147
1,08
-
41
1,00
-
1,00
-
0,35 - 20,34
33
0,21
0,04 - 1,08
0,17
0,03 - 0,99
0,15 - 5,67
31
0,63
0,18 - 2,17
0,79
0,18 - 3,44
0,12 - 5,79
50
1,39
0,51 - 3,77
1,33
0,41 - 4,23
0,92 - 10,1
114
1,00
0,98 - 1,02
1,00
0,97 - 1,02
0,94 - 1,01
155
0,99
0,96 - 1,02
0,99
0,95 - 1,03
87
1,00
64
0,60
0,25 - 1,44
0,55
41
1,00
-
1,00
113
2,02
0,72 - 5,72
2,09
Gender
Male
Female
-
1,00
0,23 - 0,93
0,34
0,13 - 0,84
-
1,00
0,20 - 1,51
Marital status
-
1,00
0,34 - 3,38
0,45
0,11 - 1,78
0,62 - 7,05
Are you in a farmers group
No
48
1,00
-
1,00
-
53
1,00
-
-
-
Yes
113
1,47
0,71 - 2,98
2,07
0,86 - 4,97
101
2,29
0,87 - 6,05
3,60
1,23 - 10,45
No education
26
1,00
16
1,00
Primary school
66
2,95
1,05 - 8,29
2,53
0,79 - 8,09
76
2,13
0,44 - 10,30
1,38
0,22 - 8,60
More then primary
57
1,67
0,57 - 4,84
1,10
0,33 - 3,55
54
1,93
0,38 - 9,78
0,97
0,15 - 6,53
79
1,00
81
1,07
0,56 - 2,03
0,80
0,37 - 1,72
126
>999
0,00 – 999**
>999
0,00 – 999
160
1,00
0,79 - 1,28
0,90
0,65 - 1,27
149
1,15
0,89 - 1,48
1,20
0,87 - 1,66
Education level
-
1,00
-
-
1,00
-
PPE
0 PPE
> 1 PPE
Continuous
-
1,00
-
23
Precautions after using pesticides
1-2 precautions
75
1,00
64
1,00
> 2 precautions
81
2,16
1,11 - 4,21
2,72
1,24 - 5,92
80
0,75
0,34 - 1,69
0,63
0,24 - 1,62
156
2,00
1,2 - 2,4
1,75
1,17 - 2,63
144
1,00
0,65 - 1,37
0,96
0,60 - 1,53
Continuous
-
1,00
-
-
1,00
-
* The adjusted analyses include the following potential confounders: district, age gender, farmer group, education level, use of PPE and
precautions.
**The huge CI for binominal PPE in Wakiso are due to the fact that no farmers are having more then 1 symptom and not using any PPE.
36
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APPENDIX
40
APPENDIX 1
Projektbeskrivelse
Viden, holdning og praksis studie, i ugandiske småbønders brug af pesticider.
Følgende projektbeskrivelse skildrer baggrunden, formålet, metoden, tidsplanen og rammerne for at
gennemføre et studie om pesticidbrug blandt bønder i Uganda studieåret i 2010-11.
BAGGRUND
Brugen af pesticider er kraftigt stigende i flere afrikanske lande. Øget efterspørgsel på fødevarer,
ændringer i klima og en stor befolkningstilvækst betyder, at de oprindelige dyrkningsmetoder ikke
længere er tilstrækkelige (Williamson, Ball & Pretty, 2007; Ntow et. al., 2006; Abate, Huis & Ampofo,
2000). Derfor har der gennem de seneste mange år været store fordele ved at bruge pesticider. Ikke blot
for dem der sælger pesticider og bonden selv, men også for de afrikanske regeringer, der lettere kan
brødføde deres befolkning (Abate et. al., 2000).
Men forkert brug af pesticider kan føre til miljøforurening og have svære helbredsmæssige konsekvenser
for de mennesker, der arbejder med dem (Sam et. al. 2007; Wesseling, Corriols & Bravo, 2005; Salameh
et. al. 2002). Hvert år dør cirka 300.000 mennesker på grund af pesticider. Hovedparten af disse dødsfald
er selvmord, der skyldes en let adgang til de meget giftige stoffer.
Hertil kommer omkring 3 millioner akutte pesticidforgiftninger pr år (Acute Pesticide Poisoning (APP))
samt et endnu større antal bønder, der rammes af kroniske forgiftningssymptomer og følgesygdomme
som hovedpine, svimmelhed, søvnløshed, øget forekomst af kræft, udslet med videre.
UN Food and Agricultral Organisation (FAO) har med sin International Code of Conduct forsøgt at
kontrollere brugen af pesticider. Blandt andet anbefaler FAO, at de pesticider, der sælges til småbønder,
kræver minimalt med beskyttelsesudstyr (Eddleston, et. al. 2002; FAO 2010). Flere studier har netop
dokumenteret en klar sammenhæng mellem manglende brug af beskyttelsesudstyr (Personal protective
equitment (PPE)) og manglende personlig hygiejne som en indikator for APP (MacFarlane et.al., 2010;
Ntow et. al., 2006; Yassin, Mourad & Safi, 2002). Anbefalingen er derfor særdeles aktuel. Endvidere har
WHO med sin Essential Drug List (EDL) - der senest blev opdateret i år 2009 - en optegnelse over de
mest farlige pesticider. Listen er et nyttigt værktøj til eliminering af de mest farlige pesticider (Eddelston
et. al, 2000, WHO 2009). Fulgte de enkelte afrikanske lande anbefalingerne kunne man sandsynligvis
sænke antallet af APP.
41
Det er det enkelte lands eget ansvar at overholde FAO anbefalingerne og WHO´s liste, men manglende
resurser og politisk vilje i udviklingslande, har desværre ofte betydet, at de ikke bliver gennemført
(Eddelston et. al, 2000; Naidoo et. al., 2010; Wesseling et. al., 2005). Endvidere har pesticid industrien
også et ansvar for fornuftig brug af pesticider. Flere firmaer påtager sig også dette ansvar, men det ser ud
til at tiltagene ikke har nogen egentlig effekt (Konradsen et. al, 2003; Murray and Tayler, 2000).
Således tegner dagens billede af pesticidbrugen i flere afrikanske lande sig ikke positivt. Flere pesticider,
som afrikanske bønder bruger, er i strid med EDL og forbudt i industrilandene. Det vurderes, at op til 25
% af de pesticider, der bruges, bliver smuglet ind i landene, og pesticidernes afmærkninger og
brugsanvisninger er ofte fraværende, mangelfulde eller skrevet på et fremmed sprog for bonden.
Endvidere har bønderne ofte hverken adgang eller råd til beskyttelsesforanstaltninger (Kondradsen et. al.,
2003; Maroni, Fait, Colosio, 1999;).
Små landbrug er essentielle for overlevelsen af flere afrikanske familier (Naidoo et. al, 2002; Abate, et. al.
2000). Uganda er ikke anderledes, her bor 28 millioner mennesker. Af disse 28 millioner bor 85 % på
landet, og de er på den ene eller anden måde afhængige af indtægter fra landbruget. En survey gennemført
af Ugandan National Association of Community and Occupational Health (UNACOH) og International
Centre for Occupational, Environmental and Public Health (ICOEPH) viser, at 90 % af bønderne bruger
pesticider. Denne survey viser også, at meget få har fået undervisning i, hvordan pesticider bruges og
opbevares korrekt, samt at flere undlader at bruge de korrekte beskyttelsesforanstaltninger og ofte har
forgiftningssymptomer (Pesticide Use, Health and Enviroment –Uganda, 2010).
Andre studier ser på den samme problematik. De viser, at problemer typisk opstår, når bonden ikke har
tilstrækkelige viden, holdning eller praksis (knowledge, attitude and praksis, KAP) omkring brugen af
pesticider. Studierne ser derfor på sammenhængen mellem de tre faktorer i relation til brug af pesticider
(Sam et al, 2007;Wesseling, Corriols & Bravo, 2005). I et studie af Ngowi, Maeda og Paranen (2002)
påpeger de eksempelvis, at bønderne ofte ikke er bevidste om deres manglende viden. Andre KAP-studier
har fundet frem til, at hvis følgevirkningerne af pesticider skal undgås, så er undervisning i brug af
pesticider vigtig. Ikke kun for bønderne, men også for resten af befolkningen (Sam et. al, 2008). Dog har
andre studier vist, at øget viden ikke nødvendigvis fører til bedre praksis (Yassin, Mourad & Safi, 2002).
Viden, holdning og praksis er også primærfokus i dette studie af pesticidbrug og forgiftningssymptomer
blandt bønder i Uganda. Endvidere er projektet en del af et større interventionsstudie om bæredygtighed,
der ønsker at mindske de negative effekter af pesticider på mennesker og i naturen blandt andet gennem
undervisning i korrekt brug af pesticider (Pesticide Use, Health and Environment –Uganda, 2010).
42
Formål
Formålet med studiet er at undersøge småbønders brug af pesticider i Uganda. Der fokuseres på fire
problemstillinger i projektet:
1. At indsamle baselinedata i det overordnede interventionsprojekt, herunder beskrivelse af
bøndernes viden, holdning og praksis omkring pesticider.
2. At klarlægge hvorledes viden har en effekt på APP, PPE, hygiejne ved sprøjtning og opbevaring
af pesticider (se figur 1).
3. At belyse hvordan selvrapporterede symptomer på APP påvirkes af PPE, hygiejne ved sprøjtning
og opbevaring af pesticider (se figur 1).
4. At observere bøndernes opbevaring og brug af pesticider.
Figur 1.
Potentielle confoundere:
Alder, køn, skolegang, antal år som
landmand, størrelse på farmen, afgrøder,
Eksponering:
område, rygning, alkoholindtagelse,.
Pesticider. Hvor ofte, hvilke
typer og hvor meget?
Viden om pesticider?
Viden omkring den akutte
og kroniske effekt af
pesticider?
Brug af PPE
Udfald:
Selvrapporterede
symptomer på
pesticidforgiftning.
Brug af PPE
Hygiejne ved sprøjtning.
Selvrapporterede symptomer på
Opbevaring
af pesticider.
pesticidforgiftning.
Hygiejne ved sprøjtning.
Opbevaring af pesticider.
Der arbejdes således ud fra følgende hypoteser:
Viden har betydning for tilfældene af selvrapporterede symptomer på pesticidforgiftning.
Viden har betydning for holdning og praksis ved håndtering af pesticider, forstået som brugen af
PPE, hygiejne ved sprøjtning og eventuelt opbevaring af pesticider.
Holdning og praksis (PPE, hygiejne ved sprøjtning og opbevaring af pesticider) har betydning for
selvrapporterede symptomer på pesticidforgiftning.
43
Metode og materiale
Design
Studiet gennemføres som et epidemiologisk tværsnitsstudie, hvor både eksponering og udfald klarlægges
samtidigt. Data vil senere blive brugt som baseline i et interventionsstudie, der blandt andet undersøger
effekten af undervisning til ugandiske bønder i brug af pesticider.
Dataindsamling
Størstedelen af dataindsamlingen vil være 300 interviews med småbønder i Uganda. Public health
studerende fra Makerere Universety, danske studerende fra Københavns Universitet samt UNACHO
personale vil være med til at udføre interviewene. Alle vil følge den samme strukturerede interviewguide
med både åbne og lukkede spørgsmål. Hvert enkelt interview vil blive foretaget ansigt til ansigt, og det vil
være intervieweren, der udfylder interviewguiden. Hvert interview forventes at tage omkring en time
inklusiv transport, så der kan gennemføres cirka otte interviews om dagen. Data vil formentlig være
indsamlet i løbet af en periode på fire uger.
Interviewguiden har fokus på viden, attitude og praksis i relation til brug af pesticider. Bøndernes viden
omkring brug af pesticider bliver sat i relation til tre faktorer: i) Symptomer på forgiftning, ii)
Beskyttende foranstaltninger og iii) Opbevaring af pesticider (se figur 1).
Symptomer på forgiftning forstås som symptomer, der er opstået umiddelbart efter, at bonden har sprøjtet.
Svarmuligheder i forbindelse med dette indføres på en allerede specificeret liste i spørgeskemaet.
Beskyttende foranstaltninger dækker både over personlig hygiejne og brug af PPE.
Information omkring opbevaring af pesticider vil blive indsamlet både via interviews, men også via
observationer. Det er dog uvist, om det kan lade sig gøre at observere opbevaringen, da det endnu er
usikkert, om interviewet kommer til at foregå i den enkelte bondes hjem eller udenfor. Hvis interviewet
foregår udenfor den enkelte bondes hjem vil det være selvrapporterede data fra spørgeskemaet, der tages
med i analysen.
Svarene fra interviewguiden vil blive indtastet i løbet af opholdet i Uganda, så eventuelle tvivlsspørgsmål
kan blive opdaget.
Foruden interviewguiden og observationsdata vil der i løbet af perioden også blive foretaget
videooptagelser. De mange besøg hos småbønder på forskellige gårde og i forskellige distrikter giver
gode muligheder for at belyse forholdene visuelt. Lignende materiale vil blive lavet i Bolivia, og
optagelserne fra de to steder vil danne grundlag for undervisningsmateriale på universitetsniveau.
44
Videomaterialet vil desuden indgå som observationer af de arbejdsforhold, bønderne har, og vil også
blive inddraget i en diskussion af baselinedata.
Population
Der er omkring 300 småbønder i områderne Wakiso og Pallisa. Bønderne i Wakiso er kendt for at dyrke
grøntsager, mens de i Pallisa især dyrker bomuld. For at blive inkluderet i studiet skal bønderne have
brugt pesticider indenfor det sidste år og givet skriftligt samtykke om deltagelse. I tilfælde af analfabeter
vil mundtligt samtykke være tilstrækkeligt. Bønderne identificeres i samarbejde med UNACOH, der
kender området og har mulighed for at lave et repræsentativt udsnit. I udvælgelsen vil der indgå et
repræsentativt antal kvinder.
Fejlkilder
Da både eksponering og udfald indsamles på samme tidspunkt, vil der være risiko for over- og
underrapportering. Endvidere vil der i forbindelse med interviews altid være mulighed for
informationsbias. Det forsøges elimineret med korte og så vidt muligt faktuelle spørgsmål og ved at
gennemgå interviewguiden med både tolk og samarbejdspartnere først. Alle henvendelser til bønder vil
blive registeret, så antallet af bønder, der ikke ønsker at deltage, kan opgøres. Endvidere vil der kunne
opstå fejlkilder i relation til selve setting. Uganda er meget anderledes kulturelt og strukturelt
sammenlignet med Danmark, og det vil have betydning for de data, der indsamles.
Dataanalyse
Der vil blive brugt logistisk regressionsanalyse til at analysere data, så der tages højde for eventuelle
modificerende faktorer. Data analyseres i det statistiske program SAS efter hjemrejse.
Potentielle confoundere vil blive analyseret én for én og sammen for at se, om de har indflydelse på
resultatet. Ligeledes tages der hensyn til eventuelle effektmodifikatorer.
Tidsplan
Oktober – november
Udarbejdelse af spørgeskema.
Etablering af kontakt med studerende ved Makerere universitet.
Primo december
Afrejse til Uganda.
De første 14 dage bruges på introduktion, planlægning og logistisk arbejde.
Indsamling af data, observationer om opbevaring af pesticider og videooptagelse.
Indtastning af data i SAS udføres løbende under opholdet.
Primo marts
Ankomst Danmark.
Statistisk behandling og analyse af data.
Udarbejdelse af videnskabelig artikel.
45
September
Artikel færdig.
Projektets rammer
Projektet er et samarbejde mellem UNACOH (Uganda National Association of Community and
Occupational Health) og Dialogos. UNACOH er en NGO fra Uganda, der ønsker at fremme en sund og
produktiv ugandisk befolkning. Dialogos er en dansk NGO, der blandt andet ønsker at bistå
befolkningsgrupper i ulande på deres selvvalgte vej væk fra fattigdom. Dialogos har desuden stor erfaring
i arbejdet med pesticider. Begge organisationer har en frivillig og demokratisk arbejdsgang.
UNACOH er ansvarlige for implementering og daglig drift af projektet, mens Dialogos står for
fundraising, implementeringskontrol og rapportering fra projektet (Pesticide use, Health and Enviroment
– Uganda 2010). Projektet skal løbe over flere år og på sigt gøres bæredygtigt (Pesticide use, Health and
Enviroment – Uganda 2010). Derudover er blandt andet ICOEPH og Københavns Universitet tilknyttet
projektet. ICOEPH arbejdede sammen med Dialogos i Bolivia-projektet ‖Plagbol‖ med stor succes, og
Københavns Universitet har et samarbejde med Makerere Universitet i Uganda.
Endvidere er der et samarbejde med Bispebjerg Arbejds- og Miljømedicinske afdeling, hvor undertegnede
har fået tildelt en specialeplads og vejleder.
Finansiering
Projektet har støtte fra Dialogos, der betaler vaccination, flyrejse og løn i Uganda, vurderet til cirka
48.000.
Budgettet er foruden støtten fra Dialogos vurderet til:
Tilskud til boligudgifter i
Pr. måned
Varighed
DKK
3000
3 måneder
9.000
11.000
7 måneder
77.000
Uganda
Løn efter Uganda
I alt
86.000
46
APPENDIX 2
PESTICIDE USE, HEALTH AND ENVIRONMENT PROJECT:
FARMER’S BASELINE SURVEY TOOL
Informed consent:
The Pesticides Use, Health and Environment Uganda Project is being carried out by UNACOH (
Uganda) and Dialogos (Denmark) in collaboration with Makerere University Faculty of Agriculture
(MUFA) and Makerere University School of Public Health (MUSPH), in the districts of Pallisa and
Wakiso.
The project aims at making the use of pesticides safer for human health, more friendly to the
environment, while maintaining and improving agricultural productivity.
The baseline survey is being carried out to inform, the project at present in the above regards, so that we
can be able to measure later on the effects of the project interventions.
Your participation therefore is useful to the project, but more importantly to the people handling
pesticides, to the environment and to the economic activities of farmers. Therefore your giving answers
to the questionnaire, attached, will help all the stakeholders referred to above.
We thank you for your cooperation.
------------------------------------------------------------------------------------------------------------------------Are you willing to participate in this interview?
If not, why?
Date and signature:
47
PESTICIDE USE, HEALTH AND ENVIRONMENT PROJECT BASELINE SURVEY TOOL
Number _____________
Name of interviewer: _____________________Supervisor: _____________________________
Date of interview: __________________________
District: __________________________________ Sub-county__________________________
Parish:_______________________________
Village _____________________________
A. Personal data:
Name___________________________
Age: ______________
Sex:
If female do you use contraceptive pills:
Marital status:
Are you in a farmers group?
Name of head of household? ________________________________________
Who makes the final decisions in agricultural production:
Who is living in your household, family relations and age (begin with eldest):
S/N
Sex
Age
Family relationship.
Can you read?
Can you write?
What is your highest attained education level?
university
How many years have you been engaged in agriculture? ____________
48
How many acres of land does the head of household own? _________________________
How many acres of land do you use for agriculture? ___________________
How many acres do you rent from other people? ____________________
In the past month, which diseases did you suffer from?
ular weakness
fficulties
B. Agricultural Aspects:
Do
Do you use pesticides (insecticides, fungicides, herbicides, acaricides, etc) in agriculture?
yes
Do you use pesticides for other purposes?
fy: __________________________________
How long have you been using pesticides? (Years)
____________________________________
Who helps you with the daily work at the farm?
Pesticide use on crops
Important Crops sprayed
Pesticides used
Types of pesticides
No. of times
(Herbicides, Fungicides,
sprayed until
Insecticides, Acaricides)
harvest
1.
2.
3.
49
Do you think you can reduce on the amount of pesticides you use in agriculture without
affecting the expected yield?
alternative
Do you know of any alternatives to pesticides for controlling pests?
If yes, which methods do you know? List
1.
_________________________________________________
2.
___________________________________________________
3. ____________________________________________________
What do you wear during pesticide spraying? (Tick all mentioned)
-sleeved
shirt
___________________________
Do you take precautions immediately after handling pesticides in your field?
If yes, which ones?
field when spraying pesticides
How long does it take you to spray the field daily?
-3 hours
How long does it take you to return to the same field after spraying?
Do you spray your products after harvesting, but before taking them to the market?
no
If yes, on what crops: ______________________________________________________
Who does the spraying in the household?
kids
50
Do you follow a particular schedule when spraying?
What determines the frequency of spraying?
Other: _________________________
How many times have you sprayed in the last month? ___________
Which pesticides did you use the last month? ___________________
What do you use for applying the pesticide?
________________________________________
In case you get a blockage of your sprayer nozzle, what do you do?
Do you clean or wash your knapsack/ sprayer after use?
If yes, where do you clean it?
Where do you mix your pesticides?
field
How do you measure the dosage of pesticides needed when mixing?
___________________
Do you mix several different pesticides in one mixture?
If yes, why
If not, why not ___________________________________________________
Training, handling and management of pesticides:
Where do you normally get pesticide information?
-dealers
What advice do you get from any above (do not mention)?
51
-harvest / entry period
Do the pesticide containers have labels on them when you buy from the dealers?
If not, why ___________________________________________
Can you read and understand instructions on pesticide labels?
If not, why? ______________________________________
Have you ever had any training on how to use and handle pesticides?
no
If yes, how many times have you participated in such training? ____________________
How long did the training on pesticide use and handling take?
When did you receive the last training?
th ago
-6 month ago
From which organisation did you receive this training?
Do the pesticide containers have any signs indicating their toxicity (how poisonous they are)?
Which signs mark the most dangerous pesticide?
Which signs mark the least dangerous pesticides?
52
Do you observe the weather condition when going to spray?
If yes, in which weather do you not spray?
Where do you store your pesticides?
up.
What do you do with the empty pesticide containers?
bage pit
What do you do in case you don’t use up all the pesticide mixed?
field
Health effects:
Do you think pesticides can have any bad/ negative effect on your health?
How do pesticides enter your body?
Have you, in the last year, felt ill immediately after handling pesticides.
If yes what symptoms did you suffer (do not mention the symptoms)?
ular weakness
ulties
ss
How long did the pesticide symptoms last on you?
53
Have you in the last month felt ill immediately after spraying pesticides?
If yes, which symptoms did you suffer? (do NOT mention any symptoms , tick if the farmer
mentions himself ) – Acute signs and symptoms
ular weakness
ss
etite
71B. (Now mention the symptoms and tick if the farmer agrees).
iness
ular weakness
ss
uth
What did you do to address the above problems?
If yes what kind of treatment did you receive? (Specify)
_____________________________
What pesticide caused you the biggest danger? _______________________________
Do you try to avoid these pesticides?
If yes, how? ___________________________________________________________
Mention the least dangerous pesticides you know?
1. ___________________________
2. __________________________
3. _________________________
Do you know of any pesticide poisonings in your village or family that happened during last
year?
54
What was the reason for the poisoning?
Do you know of any fatal pesticide poisonings that happened in your village or family last
year?
What was the reason for the fatal poisoning?
Do you think pesticides could have a negative effect on the environment?
Apart from the effects of pesticides on health, what other negative effects do they cause to the
environment? (Tick. DO NOT mention)
-target organisms / animals
Observations done by the interviewer - only if possible
What is the name (trade and active ingredient) of the pesticides stored?
1. ____________________________________________________
2. ______________________________________________________
3. _____________________________________________________
Where are the pesticides containers kept:
How are they stored:
Does the knapsack sprayer leak:
What protective equipment are present in the house:
rall wear
What is the condition of the protective equipment:
not effective
55
APPENDIX 3
Fra: Signild Vallgårda <[email protected]>
Til: Anna Hobolth <[email protected]>
Cc: Rie Laurine Rosenthal Johansen <[email protected]>
Sendt: 12:16 onsdag den 4. maj 2011
Emne: Re: SV: SV: Specialekontrakt
Kære Anna.
Rie har nok bare ikke nået at svare dig. Det jeg skrev til Rie om dit spørgsmål, og som jeg har sagt til
Emina er:
1. Det er kun den studerende som kan være forfatter på artiklen, ikke vejledere eller andre. 2. Det er en
god idé, at skrive en slags indledning eller kappe, hvor man redegøre grundigere for teori, metode og
måske øvrig forskning, da der jo ikke er så meget plads at skrive om dette i en artikel.
Som jeg også fortalte Emina, er der ikke nogen retningslinjer nu, men de vil blive udarbejdet.
Du behøver ikke at tale med Susanne. Du skal bare sørge for at få din kontrakt udfyldt.
Mange hilsener
Signild
On 04/05/11 12.12, "Anna Hobolth" <[email protected]> wrote:
Mange tak for hjælpen.
Jeg har lige snakket med Emina idag, omkring muligheden for at skrive en artikel som speciale (vi
sidder på samme kontor).
Jeg har spurgt studierådgivningen men har ikke rigtig fået noget svar.
Er der nogen retningslinjer? -og hvor kan jeg evt. finde dem. Og skal jeg også snakke med Susanne
om det?
Undskyld alle spørgsmålene.
Kh Anna
56