Associated Factors With Acute Pesticide Poisonings According To Different Criteria

Abstract

Introduction: The use of pesticides is intensive in Brazil. Acute pesticide poisoning is well known health impact however the diagnosis is still a challenge. Objective: To characterize frequency and associated factors of pesticide poisonings according to different criteria. Methods: Cross-sectional study was carried out among 492 pesticide applicators in tobacco farming, randomly selected. Socioeconomic aspects were characterized, as well as data on occupational exposure to pesticides and chemical types. The frequency of acute pesticide poisonings by many criteria was compared: recent symptoms after pesticides usage (criterion proposed by WHO), standardized medical examination, plasma cholinesterase (BChE) collected in low and high exposure period and evaluation by toxicologists, which was considered as gold standard (classified as possible or probable cases). The associations were examined using chi-square and Poisson regression. Results: The incidence of acute intoxication varied according to the criteria: 12% by medical diagnosis, 14% as possible cases and 4% as probable cases by toxicologists. The questionnaire of pesticide-related symptoms shows 11% considered as possible case and 8% as probable cases. BChE was reduced in 2.8% of organophosphates (OP) exposed and was not a reliable indicator of poisoning by OP. Multivariate analysis showed more poisonings among women and those with worst economic indicators. Dermal exposure was associated with highest frequency of intoxication by all criteria. The main chemical types associated with acute poisonings were Dithiocarbamate, Sulfentrazone, Iprodione, OP and Neonicotinoid. Conclusion: Pesticide poisoning remains a serious health problem among farmers. The study contributes to identify occupational poisonings among farmers and to qualify health professionals for diagnosis. The symptom's questionnaire showed good agreement with the toxicological assessment and can be a useful tool in health care and epidemiological studies.