Abstract
ABSTRACTOBJECTIVETo evaluate the attributes of Primary Health Care (PHC) for rural workers; to analyze sociodemographic conditions, history of poisoning and hospitalizations for pesticides and use of personal protective equipment; and to verify exposure to pesticides by determining bioindicators.METHODSCross-sectional, descriptive-analytical study with a sample of 1,027 rural workers living in municipalities belonging to a regional health department in Southern Minas Gerais, whose PHC is governed by the Family Health Strategy model. We used the adult version of the Primary Care Assessment Tool (PCATool Brazil) and a structured questionnaire to collect socioeconomic data, history of poisoning and hospitalization for pesticides and use of personal protective equipment. Blood samples were collected to measure biomarkers of pesticide exposure and signs of renal and hepatic sequelae.RESULTSLow education was prevalent, as well as the intense contact of workers with pesticides. Frequent use of personal protective equipment was higher among men, as was the history of poisoning and hospitalizations for pesticides. Rates of 20% poisoning, 15% liver disease and 2% nephropathy were detected. Signs of hepatotoxicity were more frequent in men. Gender differences were all statistically significant. Regarding PHC, only the attribute “degree of affiliation” had a high score. None of the poisoning cases detected in the study were previously diagnosed.CONCLUSIONSDespite the high coverage of the Family Health Strategy, occupational risk and its consequences have not been detected by health services, which do not seem oriented to primary care, even lacking their essential attributes. There is a need for immediate and effective adaptation of public policies regarding the health of rural workers, with adequate training of teams and review of the portfolio of PHC services offered.
Highlights
The Brazilian Constitution of 1988 determines that it is the citizen’s right and the state’s duty to ensure the health needs of the population with quality services[1]
Frequent use of personal protective equipment was higher among men, as was the history of poisoning and hospitalizations for pesticides
Despite the high coverage of the Family Health Strategy, occupational risk and its consequences have not been detected by health services, which do not seem oriented to primary care, even lacking their essential attributes
Summary
The Brazilian Constitution of 1988 determines that it is the citizen’s right and the state’s duty to ensure the health needs of the population with quality services[1]. In rural areas of Brazil, health services have lower supply and quality, as well as greater difficulty in accessing the Primary Health Units, resulting in an inequality between supply and demand in urban and rural areas[5] In the latter, the demand for care is almost always motivated by acute diseases[6]. The population receives services based on demand and not on organized supply according to its supposed or perceived needs[6,7,8] In this context, the regional health department under study, located in the south of Minas Gerais, has 21.96% of its population residing in rural areas, much higher than the national average (15.65%) and the state average (14.7%) largely due to work in coffee farms[9]. Due to the mountainous relief, mild climate and favorable soil, the south of Minas Gerais is one of the largest coffee producers in the world[10]
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