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case fatality rate of 28.5% was observed for patients in whom the class of
pesticide responsible for poisoning was not identified at the time of treatment
(Jeyaratnam et al. 1982). These findings lead to two conclusions:
In view of the inadequacy of resources for controlling the use of pesticides
in developing countries, available resources should be aimed
specifically at control of organophosphorous pesticides.
To reduce fatalities from poisoning, each country must develop and
maintain a list of the trade names of pesticides and the corresponding
chemical class. In parallel, physicians should be trained in the appropriate
therapeutic interventions against organophosphate poisoning.
Identification of factors influencing poisoning
Workers' knowledge of hazards is an important factor for the prevention of
acute poisoning. However, this knowledge must be factual and correct. Erroneous
beliefs can seriously impair workers' capacity to protect themselves
from health risks. For example, the most important route of absorption of
phenoxy herbicides is dermal, whereas absorption through inhalation is relatively
unimportant (Kolmodin-Hedman 1983). However, farm workers
believe that the inhalation route is the most important and that their knowledge
of the health risks associated with pesticide use is adequate. This misconception
may have arisen because of the obvious odour of pesticides during
spraying.
Clearly, it is urgent that worker education be established for the safe handling
of pesticides in countries of the developing world. For these workers to be
motivated to use safe practices, e.g., protective clothing, they must understand
the mechanism of poisoning. In four Asian countries, agricultural workers
identified other farmers and retail outlets as the most important sources of
information on the safe use of pesticides (Jeyaratnam et al. 1987). These
workers should be receiving instruction from health workers. Alternatively,
health services could make use of this data to integrate participatory mechanisms
in farmer education and use vendors as extrabudgetary resources for
dissemination of information on safe practices.
Poisoning episodes occur largely during spraying, mixing, and diluting of
pesticides (Table 1). The use of malfunctioning or defective equipment is also
an important factor contributing to accidental acute pesticide poisoning
among agricultural workers (Jeyaratnam 1982). Preventive measures should
focus on these areas. Copplestone (1982) states, "We are more likely to be
effective in preventing accidental poisoning by pesticides if we concentrate
our activities on those areas where hazard is really high than by trying to give
blanket coverage to all pesticide users."
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