and Integrated Pest Management - part - usaid

PESTICIDE POISONING IN SOUTiIEASTASIA 327
industrialized world is totally different from that of the developing world. It is
important that this difference is appreciated and it is for that reason that this
paper deals with the issue of acute pesticide poisoning.
Sources of Data
HOSPITAL RECORDS Much of' the existing data on acute pesticide
poisoning is derived from hospital morbidity and mortality records. Hospital
records pertain to 'in-patient' or 'out-patient' situations; the latter suffer from a
lack of completeness and hence are of little value fr scientific ana!ysis. Further,
it must be recognized that even 'in-patient' records are seldom adequate for
anyt, fing but .tively l superficial analysis. The other limiting factor of hospital
records on acute pesticide poisoning as a mcasure of the extent of 'he problem is
that itreflects only a small fraction of the real problem. In a large percentage of
patients poisoned, the condition is scll-limiting and often requires no active
treatment oi patients may treat themselves, or seek alternate forms of medical
care, hence bypassing the hospital system. The other problems relating to the
interpretation of hospital records are:
(i) The lack of denominator data: the episodes of poisoning do not relate to a
specific population at risk, hence the data cannot be used to develop
morbidity and mortality rates. This feature limits the use of such data for
purposes of comparison either internally or with that of other countries.
(ii) Limitation of representativeness of data: the data from one hospital does
not represent the situation on a national basis. Thus, it may be necessary
that either all hospital dta be studied or data from a representative sample
of hospitals be studied.
(iii) Validity of diagnosis of acute pesticide poisoning: the diagnosis of
pesticide poisoning in the hospital situation is mainly a clinical diagnosis
with the criteria for diagnosis being variable and dependent on the
characteristics of' each individual patient. The use of such diagnostic
criteria is unsuitable for epidemiological studies where questions of
sensitivity and specificity arise. If the criteria of poisoning for
epidemiological studies are too sensitive, then a large percentage of false
positives are likely to be included vs cases of poisoning. On the other
hand, if fhe criteria are too specific, then some of the positive cases are
likely to be left out, thereby increasing the number of false negatives in
the study. This problem of validity is particularly relevant to the
situation of acute pesticide poisoning as these symptoms are also
encountered in many other common clinical conditions. Thus it is
necessary to ensure that the criteria for the diagnosis of acute pesticide
poisoning be established clearly in any study attempting to assess the
extent of the problem.
SURVEY OF EXPOSED POPULATIONS Another approach available to
gather data on the extent of acute pesticide poisoning is to undertake a morbidity
survey of exposed populations such as (i) agricultural workers; (ii) public health
workers, e.g., in malaria, filaria control programs; and (iii) factory workers, e.g.,