An assessment of an integrated community-based training program to reduce pesticide exposure and enhance safety among mothers of children age 0-72 months in Ban Luang, Nan, Thailand
Creators: name: Rattanawitoon, Thanawat
Publisher: name: No Publisher Supplied
Year: 2021

description: Although exposure to chemical pesticides is known to cause negative effects on human health, farmers in Ban Luang, Nan, Thailand, continue to use them regularly to protect crops. This study focused on mothers with children between the age 0-72 months, who engaged in farm tasks with the objective of reducing pesticide exposure among these people. It was purposively conducted in Ban Fa and Ban Phi sub-districts in Ban Luang due to the high use of pesticides in these areas.This study was implemented from May 2020 to October 2020 and consisted of two phases. For phase one, 139 out of 226 farm working mothers living in Ban Fa and Ban Phi who met the inclusion criteria were interviewed using a questionnaire regarding demographic and occupational factors. They also received a blood test using cholinesterase (ChE) reactive paper to assess serum cholinesterase (SChE) which indicates pesticides in their body. As a result, the study found the 124 participants (about 90.0%) had risky or unsafe levels of SChE based on the ChE reactive tests and were included in phase two of the study. In addition, participant education, the distance from home to the farm, the number of days per week working on the farm, the duration of hours per day engaging in farm tasks and spraying or carrying of rubber sprayer hoses were reported to be the potential factors influencing risky and unsafe levels of SChE.In phase two, participants were divided into two groups. Group one included the 78 farm working mothers together with the 69 representatives including the 13 village leaders, the 13 village health volunteers (VHVs), 13 male farmers, 13 youth aged between 15 and 18 years, 13 elderly people older than 60 years, the two-chief executives of the sub-district administrative organizations and two monks. The participants were interviewed using the questionnaire on knowledge, attitude, practice (KAP) and health beliefs. This questionnaire was used to examine knowledge, attitudes, and perceptions of pesticide exposure as well as the pesticide safety practices among the participants residing in high pesticide use areas. The interview results indicated how group one lacked knowledge and had negative attitudes and perceptions towards pesticide exposure. Additionally, the participants lacked proper pesticide safety practices due to discomfort, the environment, and their lifestyle factors.Group two applied a quasi-experimental design. A systematic random sampling technique was used to recruit 78 mothers from the 124 mothers who had abnormal SChE levels in phase one. Thirty-nine mothers were randomly assigned to the intervention group and 39 to the control group. The intervention program occurred over a 3-month period and consisted of a one-day pesticide training, follow up visits, community meetings, and pesticide-related information from a local media broadcast. The 3-month control program included a one-day safety in-home training and a manual titled “Clean Home, Good Health, and Happy Life”.Before and immediately following the intervention, the participants in both groups were interviewed using the KAP and health beliefs questionnaire and received a blood test to assess acetylcholinesterase (AChE) and butyryl cholinesterase (BChE) enzymes using the Test-mate kit (Model 400). These enzymes are used to determine pesticides in human blood. AChE is mainly present in red blood cells and can last between 90 and 120 days. BChE exists mostly in plasma and can last about 30 - 50 days. Furthermore, these tests were evaluated independently by a village health volunteer to assess in-home pesticide safety practices using a standardized checklist.Overall, using an analysis of covariance to adjust the levels of AChE and BChE before the intervention, we observed no significant change in AChE in part because AChE requires a longer period (up to three to four months) to recover. However, we found a significant improvement in BChE (p&lt;0.05), a marker of short-term recovery, in the intervention group in part because BChE can last about 30 – 50 days after eliminating pesticides. This study was conducted over a 3-month period. In addition, after adjusting the scores of KAP and health beliefs derived from HBM, there was a significant improvement on knowledge, attitudes, practices, and beliefs about chemical pesticide exposure after the intervention. Furthermore, using a paired t-test to investigate the in-home pesticide safety assessment, we found a significant increase in pesticide safety practices (p&lt;0.05) in the intervention group and a borderline statistically significant increase regarding in-home safety (p=0.051) in the control group. The significant increase in in-home safety in the control group could affirm the efficacy of the pesticide safety program in the intervention group. Based on the results, the constructs of the intervention program appear to be effective. Further study should be conducted to enable data collection over a longer period of time, with a larger number of subjects providing a baseline of ChE levels before pesticide exposure.