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Evaluation will be an important part of this process. Key questions to consider include: At what level or stage of medical training should this material be introduced for best results? How compatible are the concepts and approaches with the rest of the curriculum the students use? Will the module contribute to changes in behaviour and activities of the future graduates, i.e., involvement in health-promotion activities, in collection of essential data and record-keeping in rural hospitals, and in approaches to diagnosis and management of pesticide-related poisoning incidents? The trend toward community-oriented education in institutions teaching health sciences throughout the developing world presents an important opportunity to reform the attitudes and behaviours of physicians, particularly as they relate to the health problems associated with pesticide use. Pesticide use, and other occupational or environmental health issues, are especially suited to this learning approach because of their multidisciplinary nature. Acknowledgments-This project was made possible by the Young Canadian Researchers' Award program of the International Development Research Centre, Ottawa, Canada. I am deeply grateful to Dr Chitr Sitthi-amorn, my supervisor at Chulalongkom University. His dedication and vision of a healthier world with dignity for all has been an inspiration. FAO (Food and Agriculture Organization of the United Nations). 1986. International code of conduct on the distribution and use of pesticides. FAO, Rome, Italy. 31 pp. Foo Gaik Sim. 1985. The pesticide poisoning repore a survey of some Asian countries. International Organization of Consumers' Unions, Penang, Malayasia. Gaston, C. 1988. Promoting safe and efficient use of pesticides: a report on trends in pesticide use in Southeast Asia and the level of compliance with the FAQ international code of conduct on the distribution and use of pesticides. Kasetsert University, Bangkok, Thailand. Jayaratnam, J.; Lun, K.C.; Phoon, W.O. 1987. Survey of acute pesticide poisoning among agricultural workers in four Asian countries. Bulletin of the World Health Organization, 65, 521-527. MacDonald, P.J.; Chong, J.P.; Chongtrakul, P.; Neufeld, V.R.; Tugwell, P.; Chambers, L.W.; Pickering, R.J.; Qates, M. 1989. Setting educational priorities for learning the concepts of population health. Medical Education, 23, 429-439. 223
Neufeld, V. 1989. Community-based medical education: some recent initiatives toward making medical education more responsive to national health priorities. Annals of Community-Oriented Education, 2,65-84. Norman, G.R. 1988. Problem-solving skills, solving problems and problem-based learning. Medical Education, 22. Sitthi-amorn, C. 1989. Clinical epidemiology: a population targetted approach to health reform. Chulalongkorn University Printing House, Bangkok, Thailand. Thailand, Department of Health. 1988. Occupational health organization in Thailand. Occupational Health Division, Department of Health, Ministry of Public Health, Bangkok, Thailand. Wongphanich, M.; Prasertsud, P.; Samathiwat, A.; Kongprasart, S.; Kochavej, L.; Bupachanok, T.; Samarnsin, S. 1985. Pesticide poisoning among agricultural workers. Report to the International Development Research Centre, Ottawa, ON, Canada. 186 pp. Appendix: Community-targeted, problem-based (CTPB) learning module in occupational and community health- Pesticide poisoning Problem summary This CTPB learning module deals with pesticide poisoning, a prevalent occupational-health issue in Thailand. The clinical scenario presented describes a woman reporting to an out-patient clinic with symptoms of mildmoderate poisoning by organophosphate insecticide. As is often true in occupational exposure to pesticides, the diagnosis is made mainly by a thorough history-taking rather than clinical examination and diagnostic testing. Severe poisoning does, of course, occur (more commonly in Thailand by intentional ingestion), and there are opportunities in this module to learn proper emergency management. The module encourages students to think critically, formulate important questions, and evaluate the effectiveness (and limitations) of current diagnostic tests; epidemiologic data available in Thailand and; community health aspects of prevention. The subjects covered in this module include: History-taking and clinical skills; Signs and symptoms (acute and chronic) associated with organophosphate pesticides; 224
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Impact of pesticide use on health i
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IMPACT OF PESTICIDE USE ON HEALTH I
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©International Development Researc
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Contents Acknowledgments viii Forew
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Control of disease vectors: a curre
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Foreword From their first appearanc
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PART! EPIDEMIOLOGY OF PESTICIDE POI
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Although pesticides are used both i
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Table 1. Introduction of pesticides
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problem. The International Developm
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impact of pesticides on Canadian wi
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investigated further. For example,
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Conclusions The subject of this vol
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Jusoh Mamat, M.; Anas, A.N.; Heong,
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Health-risk assessment of pesticide
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especially in the absence of comple
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depends largely on external factors
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Specific situations may require spe
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that the best possible work is done
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doses (chronic poisoning) or delaye
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Table 1. Poisoning incidents in fou
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Pesticide research for public healt
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Current pest control practices in T
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800- 400- 200 - 1980 1981 1982 1983
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designed 30-40 years ago (Jusoh Mam
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and tore easily. One investigation
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education, mass-communication tools
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Increase and improve training activ
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Castaneda, C.P. 1988. Pesticide poi
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Ooi, A.C.P.; Heong, K.L.; Lim, B.K.
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Investigations into acute pyrethroi
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Level of exposure To assess the lev
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Table 2. Cases of acute pyrethroid
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(in 121 subjects), usually develope
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Deltamethrin was detectable in the
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pyrethroid poisoning. Therefore, th
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Gilliatt, R.W.; Willison, R.G. 1963
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Table 1. Value of imported pesticid
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Study two Twelve farmers participat
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All activities Left hand (73.2) Lef
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Acknowledgment- The three studies r
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Since the creation of Pakistan in 1
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Table 1. Incidents of pesticide poi
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Sandu, S.S.; Waters, M.D.; Simmon,
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and chlordane. Pest resistance to t
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young workers was 15.8%, 6.8%, and
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Storage of pesticides Although the
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Discussion The lowland regions and
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Pulmonary obstructive disease in a
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To investigate the presence and mea
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Age (years) Table 1. Distribution o
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was among paraquat users who smoked
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Levin, P.J.; Klaff, L.J.; Rose, A.G
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the delta. The total population of
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The successive and simultaneous rel
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on clinical studies and laboratory
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This made the collection of blood s
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Table 1. Relation between informati
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analysis, and engaging in various t
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Table 1. Value (million KSH) of pes
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To develop a health-education packa
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Storage site Table 3. Storage of ag
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Table 5. Causes of agrochemical and
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Methods A pilot field survey was un
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Conclusion The practices followed b
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manufactured or formulated locally,
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However, based on individual compla
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Table 4. Acetylcholinesterase activ
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Age did not appear to be an importa
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eactions to the pesticides in occup
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Bowers, M,B.; Goodman, E.; Sim, V.M
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Extent of exposure of farm workers
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Group III consisted of 31 farmers w
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25 - 0 Level of exposure J Group 1,
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Pesticides were stored everywhere c
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Table 2. Concluded. Question Answer
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PART II RELATING PESTICIDE DEVELOPM
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Toxicity Table 1. Requirements and
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Screening Process development Route
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Progress in improving safety Pestic
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type of formulation, and warning pr
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The pyrethroid, cypermethrin, is mo
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Studying the effects of pesticides
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of the risk is a quantitative issue
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egistry could be linked to the lice
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poisoned through mishandling of an
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no documented incident could be fou
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Region Table 3. Use of using pictog
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of fluorinated HDPE because fluorin
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Current initiatives, at the interna
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inding within their jurisdictions.
Page 183 and 184: Benefits of a hazard auditor From t
Page 185 and 186: different agencies take to be permi
Page 187 and 188: industry and of its serving to legi
Page 189 and 190: Anonymous. 1988a. FAO code of condu
Page 191 and 192: (Adam 1976; Fraser and Burrill 1979
Page 193 and 194: in the lower price categories tend
Page 195 and 196: Anas, N.; Jusoh Mamat, Md.; Heong,
Page 197 and 198: Zam, A.K. 1980. Bancian pengurusan
Page 199 and 200: Materials and methods Assessment of
Page 201 and 202: At the end of each day's operations
Page 203 and 204: Table 3. Number of garments chafing
Page 205 and 206: underlines the need to change attit
Page 207 and 208: Evaluation and management of pestic
Page 209 and 210: target and react with some crucial
Page 211 and 212: scientists on a contractual basis,
Page 213 and 214: pesticides in developing countries
Page 215 and 216: Regional information resources for
Page 217 and 218: Table 2. Number of enquiries receiv
Page 219 and 220: extent of this problem in developin
Page 221 and 222: Promoting the safe use of pesticide
Page 223 and 224: pests) is observed. Thus, the "quic
Page 225 and 226: is one of principal agencies respon
Page 227 and 228: Pretesting materials in training an
Page 229 and 230: of costly medical technologies and
Page 231 and 232: The agricultural sector has by far
Page 233: At the community level, the extent
Page 237 and 238: Outline for learning module using o
Page 239 and 240: WHO (World Health Organization). 19
Page 241 and 242: In the past decade, tremendous effo
Page 243 and 244: Jiang-Su province Results and discu
Page 245 and 246: As a result of deregulation, the nu
Page 247 and 248: Table 3. Proportion of workers usin
Page 249 and 250: Shih, J.H.; Wu, Z.Q.; Zhang, Y.X.;
Page 251 and 252: Pesticides and wildlife: a short gu
Page 253 and 254: Using target-specific products mini
Page 255 and 256: specifications. Other data are asse
Page 257 and 258: Formulation-specific concerns The e
Page 259 and 260: mirex, and chiordecone have been ba
Page 261 and 262: 1984). The base for pesticide granu
Page 263 and 264: e more stringently reviewed. In Can
Page 265 and 266: For example, searching for carcasse
Page 267 and 268: overlooked. In developing countries
Page 269 and 270: Establish monitoring programs to de
Page 271 and 272: Grue, C.E.; Fleming, W.J.; Busby, D
Page 273 and 274: Schafer, E.W., Jr; Brunton, R.B. 19
Page 275 and 276: Table 1. Prevalence and distributio
Page 277 and 278: By 1980, resistance to at least one
Page 279 and 280: tries. Japanese encephalitis has be
Page 281 and 282: to the targeted larvae of mosquitoe
Page 283 and 284: The role of the community Many prob
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from locally available sacking mate
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services. The project also includes
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Maxwell, C.A.; Curtis, C.F.; Haji,
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Botanical pesticides: optimizing pe
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neurotoxin but a cytotoxin, cross-r
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MoDuscicide- and pesticide-developm
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A development plan has been identif
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and environmental effects must be d
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Devitt, B.D.; Philogène, B.J.R.; H
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Endod, a potential natural pesticid
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University in Ottawa, and in other
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in the field (Lugt 1981), 137 500 m
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Hutchinson, J.; Dalziel, J.M. 1929.
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Community participation, including
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Acknowledgment- This research has b
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multiplication. The high temperatur
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Because pesticides are required in
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Africa and now East Africa. The suc
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Integrated pest management 1PM may
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to risk crop damage. Close involvem
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Ramos-Ocampo, V.E.; Magallona, E.D.
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esidues on fresh and cooked vegetab
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Grassy strip 108 N Farmer's Experim
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Table 1. Description and efficiency
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Table 3. Cost (PHP) of pest managem
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in the field. These pests were the
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PART V APPENDICES
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Ravindra Fernando, National Poisons
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Frank White, Pan-American Health Or
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ECHO abdominal ultrasonograph EEG e
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URT upper respiratory tract USAID U
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