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The health-care system The provision of health services in Pakistan has progressed faster than education, but there is still considerable room for improvement. Indicators available for recent years on health infrastructure and expenditure provide evidence of this. At present, less than 1% of the gross national product is spent on health. In 1985-1986, only 4.5% of total public spending was allocated to the health sector. The poor health situation in Pakistan is reflected in its high rates of infant mortality (95 per 1 000) and low life expectancy (61 years) compared with other countries (UNICEF Country Classification - Pakistan Basic Data from 1988 and earlier years). Today, there is one public physician for every 3400 people, one public nurse for 7.4 hospital beds or for 13 100 people, one public hospital for 150 000 people, and one hospital bed for 1 760 people. Primary health-care facilities other than hospitals are offered by 2 468 basic-health units, 455 rural-health centres, 869 maternal- and child-health centres, and 3 994 dispensaries (Government of Pakistan 1987). Along with public-health facilities, some health facilities are also made available by the private sector. However, these are expensive and beyond the reach of most of the population. Despite the official statistics, many physician posts remain vacant in the countryside. For these reasons, physicians seldom have the opportunity to treat farm workers and their experience with pesticide poisonings is often limited. Outbreaks of pesticide poisoning in Pakistan Several outbreaks of pesticide poisoning have been reported (Table 1). Peasants driven by starvation to eat treated grain have been the victims in most of these poisonings. In one instance, 34 people were affected and four died after eating mercury-treated grain (Hag 1963). In 1976, an outbreak of organophosphate insecticide poisoning from malathion occurred among 7 500 fieldworkers in the malaria control program. It is estimated to have affected 2 800 workers and resulted in at least 5 deaths. Subsequent field studies have associated low red-blood cell cholinesterase activity with the signs and symptoms of organophosphate intoxication. The greatest toxicity was found with products containing high amounts of isomalathion, a toxic product of malathion degradation. When malathion and fenitrothion poisoning was diagnosed in exposed Pakistani workers, cholinesterase activity was found to have decreased by more than 50% (Miller and Shah 1982). This exposure was attributed to poor work practices, which had developed when DDT was the primary insecticide used for malaria control. These practices resulted in excessive skin contact and percutaneous absorption of the organophosphate pesticides (Baker et al. 1978). Evidence of the widespread effect of this has been found in the increased organochiorine 72
Table 1. Incidents of pesticide poisoning in Pakistan. Work or material Number of Number of Year Pesticide involved contaminated cases deaths Reference 1%1 Organic mercury Seed-grain 100 4 Haq 1963 1969 Methylmercury Seed-grain 100 Elhassani 1982 1972 Phosphate Unloading a truck 7 Baloch 1985 1976 Malathion Application, mixing 2 800 5 Baker et al. 1978 Isomalathion 1980 Organophosphate Loading, mixing 200a Baloch 1982 1982 Malathion Application 68b Miller and Shah 1982 Fenitrothion a Most of the workers had low cholinesterase activity bOnethird of workers had cholinesterase activity below 62.5% of normal.
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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
Page 33 and 34: depends largely on external factors
Page 35 and 36: Specific situations may require spe
Page 37 and 38: that the best possible work is done
Page 39 and 40: doses (chronic poisoning) or delaye
Page 41 and 42: Table 1. Poisoning incidents in fou
Page 43 and 44: Pesticide research for public healt
Page 45 and 46: Current pest control practices in T
Page 47 and 48: 800- 400- 200 - 1980 1981 1982 1983
Page 49 and 50: designed 30-40 years ago (Jusoh Mam
Page 51 and 52: and tore easily. One investigation
Page 53 and 54: education, mass-communication tools
Page 55 and 56: Increase and improve training activ
Page 57 and 58: Castaneda, C.P. 1988. Pesticide poi
Page 59 and 60: Ooi, A.C.P.; Heong, K.L.; Lim, B.K.
Page 61 and 62: Investigations into acute pyrethroi
Page 63 and 64: Level of exposure To assess the lev
Page 65 and 66: Table 2. Cases of acute pyrethroid
Page 67 and 68: (in 121 subjects), usually develope
Page 69 and 70: Deltamethrin was detectable in the
Page 71 and 72: pyrethroid poisoning. Therefore, th
Page 73 and 74: Gilliatt, R.W.; Willison, R.G. 1963
Page 75 and 76: Table 1. Value of imported pesticid
Page 77 and 78: Study two Twelve farmers participat
Page 79 and 80: All activities Left hand (73.2) Lef
Page 81 and 82: Acknowledgment- The three studies r
Page 83: Since the creation of Pakistan in 1
Page 87 and 88: Sandu, S.S.; Waters, M.D.; Simmon,
Page 89 and 90: and chlordane. Pest resistance to t
Page 91 and 92: young workers was 15.8%, 6.8%, and
Page 93 and 94: Storage of pesticides Although the
Page 95 and 96: Discussion The lowland regions and
Page 97 and 98: Pulmonary obstructive disease in a
Page 99 and 100: To investigate the presence and mea
Page 101 and 102: Age (years) Table 1. Distribution o
Page 103 and 104: was among paraquat users who smoked
Page 105 and 106: Levin, P.J.; Klaff, L.J.; Rose, A.G
Page 107 and 108: the delta. The total population of
Page 109 and 110: The successive and simultaneous rel
Page 111 and 112: on clinical studies and laboratory
Page 113 and 114: This made the collection of blood s
Page 115 and 116: Table 1. Relation between informati
Page 117 and 118: analysis, and engaging in various t
Page 119 and 120: Table 1. Value (million KSH) of pes
Page 121 and 122: To develop a health-education packa
Page 123 and 124: Storage site Table 3. Storage of ag
Page 125 and 126: Table 5. Causes of agrochemical and
Page 127 and 128: Methods A pilot field survey was un
Page 129 and 130: Conclusion The practices followed b
Page 131 and 132: manufactured or formulated locally,
Page 133 and 134: 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.
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Benefits of a hazard auditor From t
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different agencies take to be permi
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industry and of its serving to legi
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Anonymous. 1988a. FAO code of condu
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(Adam 1976; Fraser and Burrill 1979
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in the lower price categories tend
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Anas, N.; Jusoh Mamat, Md.; Heong,
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Zam, A.K. 1980. Bancian pengurusan
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Materials and methods Assessment of
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At the end of each day's operations
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Table 3. Number of garments chafing
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underlines the need to change attit
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Evaluation and management of pestic
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target and react with some crucial
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scientists on a contractual basis,
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pesticides in developing countries
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Regional information resources for
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Table 2. Number of enquiries receiv
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extent of this problem in developin
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Promoting the safe use of pesticide
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pests) is observed. Thus, the "quic
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is one of principal agencies respon
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Pretesting materials in training an
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of costly medical technologies and
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The agricultural sector has by far
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At the community level, the extent
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Neufeld, V. 1989. Community-based m
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Outline for learning module using o
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WHO (World Health Organization). 19
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In the past decade, tremendous effo
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Jiang-Su province Results and discu
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As a result of deregulation, the nu
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Table 3. Proportion of workers usin
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Shih, J.H.; Wu, Z.Q.; Zhang, Y.X.;
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Pesticides and wildlife: a short gu
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Using target-specific products mini
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specifications. Other data are asse
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Formulation-specific concerns The e
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mirex, and chiordecone have been ba
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1984). The base for pesticide granu
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e more stringently reviewed. In Can
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For example, searching for carcasse
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overlooked. In developing countries
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Establish monitoring programs to de
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Grue, C.E.; Fleming, W.J.; Busby, D
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Schafer, E.W., Jr; Brunton, R.B. 19
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Table 1. Prevalence and distributio
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By 1980, resistance to at least one
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tries. Japanese encephalitis has be
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to the targeted larvae of mosquitoe
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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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