|Year : 2016 | Volume
| Issue : 1 | Page : 115-120
Knowledge, attitudes, and practices of organophosphorus pesticide exposure among women affiliated to the Manshat Sultan Family Health Center (rural area) in Menoufia governorate: an intervention study
Taghreed M Farahat1, Hala M Shaheen1, Zakaria F Sanad2, Nagwa A Frag1
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
|Date of Submission||30-Sep-2014|
|Date of Acceptance||06-Nov-2016|
|Date of Web Publication||18-Mar-2016|
Nagwa A Frag
MSc, Department of Family Medicine, Faculty of Medicine, Menoufia University, 3 Amer Street, Shebin El-Kom City, 32511 Menoufia Governorate
Source of Support: None, Conflict of Interest: None
The aim of this study was to determine the impact of an educational program in terms of the knowledge, attitudes, and practices of organophosphorus (OP) pesticides among women in rural areas.
OP pesticides are used widely in developing countries despite their known toxicity. Unsafe use of pesticides is common in developing countries. In Egypt, many pesticides are used to control pests in agriculture.
Patients and methods
A quasi interventional study was carried out that included 40 pregnant women exposed to OP pesticides. The study was carried out during the period from the 1 July 2012 to the end of June 2013. Knowledge, attitudes, and practices of OP pesticide exposure were assessed using a predesigned questionnaire. A postintervention evaluation was carried out after 6 months.
The mean SD age of the participants was 26.3 3.93 years. The majority of knowledge parameters including source of knowledge, route of entry, symptoms of long-term OP pesticide exposure or toxicity, and parameters related to all attitudes improved significantly after the implementation of a health education program (P < 0.05). The majority of practice parameters, including the use of OP pesticides in the home or field, following the instructions written on the pesticide bottle's label, and checking the expiry date, improved significantly after the implementation of a health education program (P < 0.05).
The level of knowledge, attitudes, and practices of OP pesticides were low. The educational sessions improved the level of knowledge, attitudes, and practices among the participants.
Keywords: Attitude, knowledge, organophosphates, pesticides, practice, women
|How to cite this article:|
Farahat TM, Shaheen HM, Sanad ZF, Frag NA. Knowledge, attitudes, and practices of organophosphorus pesticide exposure among women affiliated to the Manshat Sultan Family Health Center (rural area) in Menoufia governorate: an intervention study. Menoufia Med J 2016;29:115-20
|How to cite this URL:|
Farahat TM, Shaheen HM, Sanad ZF, Frag NA. Knowledge, attitudes, and practices of organophosphorus pesticide exposure among women affiliated to the Manshat Sultan Family Health Center (rural area) in Menoufia governorate: an intervention study. Menoufia Med J [serial online] 2016 [cited 2019 Jun 26];29:115-20. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/115/179000
| Introduction|| |
Organophosphorus (OP) compounds are one of the most important classes of pesticides and the most commonly used insecticides worldwide. There are more than 100 different OP that are used widely as insecticides and to a lesser extent as herbicides . Agriculture is the largest sector in Egypt, employing nearly 40% of the Egyptian work force, and remains the least developed sector of the Egyptian economy .
Pesticides exert adverse effects on human health as they affect the immune system, the endocrine system, and the nervous system. There are many reasons for the lack of safety measures among Egyptian farmers and their families: illiteracy, unavailability of protective devices, low awareness of the dangers of pesticide contamination, and lack of legislation regulating pesticide use .
Reduction of exposure to pesticides is possible not only through environmental control measures but also with the use of personal protective equipment to cover the hands, the respiratory tract, and the entire body. Other important preventative measures include frequent changes and washing of work clothes and education and training of workers on correct preventive behaviors ,.
The lack of information at all levels may be one of the most important causative factors of OP intoxication in developing countries. Research should focus on safe behaviors of pesticide use. This should be done concurrently with proper prospective and retrospective surveys. More information should be sought relative to the decision processes of import, legislation, and licensing. Research and development efforts in appropriate technology and safety devices are also critically needed .
The aim of this study was to assess the knowledge, attitudes, and practices among women exposed to OP pesticides during application in cotton crops plantation and to assess the impact of an educational program on their knoweldge, attitude and practice (KAP).
| Patients and methods|| |
This is an NRCT study (before and after) carried out in the Manshat Sultan Family Health Center, Menouf district, Menoufia, Egypt. The study was carried out during the period from the 1 July 2012 to the end of June 2013. The study was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University. An informed consent was obtained from all participants after a simple and clear explanation of the research objectives was provided. The sample was a purposive sample.
This study included 40 four pregnant women in their second trimester attending the Family Health Clinic and who fulfilled the inclusion and exclusion criteria. Of the 40 women who participated in the study (response rate, 90.9%), four (9.1%) refused to complete the questionnaire and to complete the study. The total dropout rate was four (9.1%). Participants were eligible for the study if they were 18-35 years of age, living in an agricultural area within 20 m of fields, or had husbands who were engaged in jobs involving application of OP pesticide or were helping their husbands in the field during cultivation of cotton crops or if they were engaged in agricultural work themselves. The participants were excluded if they had a history of chronic disorders (diabetes, hypertension, etc.), obstetric history with a previous or a recent history of pregnancy complications (gestational diabetes or hypertension or preeclampsia, etc.), multiple births or previous congenital malformation, and current multiple pregnancies. Women who were difficult to follow up (such as those traveling or participating in another study) and uncooperative participants were also excluded.
Informed written consent was obtained from each participant. Assessment of participants' KAP was performed using a predesigned questionnaire that was administered through face-to-face interviews. The questionnaire was based on the United States Environmental Protection Agency's questions related to safe pesticide use and on questionnaires used in similar previous studies ,.
The questionnaires were translated into the Arabic language and the questionnaires were accepted after validation. The questionnaire included four sections. The first section included a basic evaluation of the participants including personal history such as name, age, residence, and socioeconomic status according to Ibrahim and Abdel-Ghaffar  using four parameters (occupation, education, family size, and family income), and asking participants about the indoor use of pesticide and their housing condition.
The second section of the questionnaire consisted of questions that assessed participants' knowledge of OP pesticides. It included seven questions on the source of their knowledge, routes of OP entry, acute and chronic health effects, populations at risk for exposure, toxicity symptoms, first aid measures, and effective methods to prevent exposure . Knowledge was considered satisfactory if the percentage of good knowledge was 75-100%.
The third section of the questionnaire consisted of questions to assess participants' attitude toward OP pesticides. It included five questions on beliefs of the danger of OP pesticides, the importance of reading or understanding the labels on pesticides, reuse of its container, the importance of using protective clothes during application of OP pesticides in the home or field, and whether they were interested in learning about safe methods for the use of OP pesticides. The attitude was considered positive if the percentage of positive attitude was 75-100%.
The fourth section of the questionnaire consisted of questions to assess participants' practices of use of OP pesticides. It included seven questions on whether they used OP pesticides in the home or field, followed the instructions on the pesticide bottle's label and checked the expiration date, closed the windows during the OP pesticide application, children played outside during the OP pesticide application, washed vegetables or fruits before eating, and stored or reused empty pesticide bottles. The practice was considered good if the percentage of practice was 75-100%. The postintervention assessment was carried out 6 months after the pretest using the same questions as in the pretest.
Data processing and statistical analysis
A personal computer was used for data collection. Data were interpreted and analyzed using the SPSS program (version 16; SPSS Inc., Chicago, Illinois, USA). P value less than 0.05 was considered statistically significant. Data were described as mean and SD. The ν2 -test was carried out for analysis of qualitative variables.
| Results|| |
In terms of the sociodemographic characteristics of the studied group, the response rate was 91% (n = 40) of a total of 44 participants. The mean ± SD age of the participants was 26.3 ± 3.93 years. Results of educational levels of the participants showed that 49% had received higher education. In terms of occupation, 72.5% of the participants were housewives and 50% of them were from middle socioeconomic level.
In terms of knowledge before implementation of an educational program in this study, it was found that 72.5% of the participants in the exposed group had heard about OP pesticides from radio and TV, 25% from newspapers, and 30% from other sources such as lecturers and agriculture units. The most common symptoms known to the participants were gastrointestinal symptoms and skin manifestations (32.5 and 32.5%, respectively), and 55% of the participants knew that pesticides exert an adverse effect on human health.
In terms of attitudes, this work indicated that 62.5% of the respondents believed that pesticides are poisonous and 72.5% believed that it is necessary to read or understand the label on OP pesticide containers.
In terms of practices in this study, 47.5% of participants did not close windows during the application of pesticides, but only 20% closed windows during application of pesticides, 22.5% instructed their children to play outside during application of pesticides, 52.5% washed vegetables and fruits before eating, 25% followed the instruction on the product label, and 20% checked the expiration date of the pesticide.
The majority of knowledge and practice parameters and all parameters of attitudes in terms of exposure to OP pesticides improved significantly after implementation of a health education program (P < 0.05). The mean scores of participants' knowledge, attitudes, and practices of OP pesticide use before implementation of an educational program were 53.95 ± 6.92, 10.65 ± 3.01, and 18.97 ± 7.64, respectively, which improved significantly after the program (55.35 ± 3.23, 11.15 ± 2.23, and 19.27 ± 2.90, respectively; P < 0.05) [Table 1],[Table 2],[Table 3] and [Table 4].
|Table 2: Knowledge of pesticide exposure among the exposed group before and after the implementation of an educational|
program according to USEPAQa
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|Table 3: Attitude of pesticide exposure among the exposed group before and after the implementation of an educational|
program according to USEPAQa
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|Table 4: Practice of pesticide exposure among the exposed group before and after the implementation of an educational|
program according to USEPAQa
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| Discussion|| |
OP pesticides are used extensively in agriculture worldwide. It represents more than 80% of the total pesticides used in Egypt since 1995 . In Egypt, 14% of working women work in the agriculture sector . Studies of pesticides are considered important to decrease the risks of pesticide use and help to improve public health policies .
One of the important aims of this study was to assess the knowledge, attitudes, and practices of pregnant women toward pesticide exposure and provide interactive lectures on protective measures. In this study, it was found that the knowledge, attitudes, and practices of the participants in the exposed group were low. Studies in developing countries of farmers' knowledge and practices have reported low to moderate levels of knowledge of pesticides .
In terms of knowledge before implementation of an educational program in this study, it was found that 82.5% of responders were aware that the route of entry was oral, followed by ingestion (50%) and dermal (37.5%). This is not in agreement with the result of Yassin et al. , who studied knowledge of pesticides in Giza Strip in a sample of 200 participants and found that the dermal route was the main route of entry (88.4%), followed by ingestion of pesticide, either accidentally or to attempt suicide (87.8%).
The most common symptoms known among participants were gastrointestinal symptoms and skin manifestation (32.5 and 32.5%, respectively). These are in agreement with the findings of the study of Nalwanga and Ssempebwa , who also found that gastrointestinal symptoms and skin manifestations are the most common (38 and 36.5%, respectively), and with the Zyoud et al.'s  study, who reported that skin rash and diarrhea as the most common symptoms (37.5 and 21.5%, respectively).
In this study, 72.5% of respondents were aware that workers in the agriculture sector are at high risk of exposure and 70% were aware that farm residents are also are at a high risk of exposure. This is in agreement with the study of Ajayi and Akinnifesi , who reported that workers in the agriculture sector, especially sprayers, applicators, farmers, and farmers' families including subpopulations such as children and pregnant women, are at a higher risk than the general population.
In this study, 55% of the participants were aware that pesticides exert adverse effects on human health. This is in agreement with the result of Ribeiro et al. , who found that over 65% of the participants considered that use of pesticides could adversely affect their health.
In this study, 27.5% of the respondents knew first aid measures and 40% knew the importance of using personal protective clothes. These are higher than the results reported by Gaber and Abdel-Latif , who reported that 9 and 17% knew first aid measures and the importance of using personal protective clothes, respectively. This may have been because of differences in the education level of the participants in the two studies.
In terms of beliefs of the potentially poisonous nature of pesticides and the importance of reading pesticides' labels, these are in agreement with the study of Damalas and Hashemi , who reported that 76% of responders believed that most pesticides are harmful, 66% agreed that it is important to read pesticides' labeling, and 72% agreed that most of the information on pesticide labels is difficult to read, whereas the vast majority (94%) agreed that most of the information on pesticide labels is difficult to understand. This result shows that 67.5% of the participants were aware of the importance of wearing protective clothes. These are in agreement with the results of the study of Hashemia et al. , who found that 69% of the responders were aware of the importance of wearing protective clothes. The mean attitude score was statistically significantly high after the implementation of an educational program relating to the pervious finding on OP pesticides.
The results of this study were lower than those reported by Gaber and Abdel-Latif , who reported that most (71.4%) of the participants stated that they read the labels on the pesticide containers and 49.9% of the participants stated that they followed the label instructions. A study carried out in Ethiopia by Mekonnen and Agonafir  found that most of the farmers did not read instructions on pesticides' packages because they were illiterate or just reluctant to read them.
Also, it was found that 77.5% of women stored the empty containers in any place either inside or outside the home and 12.5% reused empty bottles. These results are in agreement with those of Zhang and Lu , who reported that the majority of farmers discarded empty pesticide containers into the environment. Also, Recena et al.  found that 54.4% of farmers stored the empty containers in their houses. In contrast, Silva et al.  reported that most of the participants stored the pesticide products in a reserved place outside the house and turned over the empty containers over to the National Empty Container Processing Institute.
This study found that participants' practices in terms of following the instructions on the product label, checking the expiration date, washing of vegetables and fruits before eating, reuse of empty OP pesticide bottles or cans, and use of protective clothes improved significantly after the program. This study found that 92.5% of the respondents had satisfactory knowledge, 70% had a positive attitude towards the guidelines on the use of OP pesticides, and 55% followed good practices. These findings are in agreement with those of Yang et al. , who reported that educational programs targeted at age groups including topics related to proper disposal of pesticide waste under sufficient supervision of authorities should consequently be considered to improve the levels of knowledge and awareness of the dangers of pesticides to human health and environmental pollution in the Wei River catchment, China.
| Conclusion|| |
The level of knowledge, attitudes, and practices of use of OP pesticides were low. Educational sessions improved the level of knowledge, attitudes, and practices among the participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kapka-Skrzypczak L, Cyranka M, Skrzypczak M, Kruszewski M. Biomonitoring and biomarkers of organophosphate pesticides exposure - state of the art. Ann Agric Environ Med 2011; 18
Abouleish I. The right livelihood award. Available at: http://www.rightlivelihood.org/recip/2003/sekem.htm
. Accessed March 2014].
Gaber S, Abdel-Latif SH. Effect of education and health locus of control on safe use of pesticides: a cross sectional random study. J Occup Med Toxicol 2012; 7
Wilson C, Tisdell C. Why farmers continue to use pesticides despite environmental, health sustainability costs? Ecol Econ 2001; 39
Botella B, Crespo J, Rivas A, Cerrillo I, Olea-Serrano MF, Olea N. Exposure of women to organochlorine pesticides in Southern Spain. Environ Res 2004; 96
Hurtig AK, San Sebastián M, Soto A, Shingre A, Zambrano D, Guerrero W. Pesticide use among farmers in the Amazon basin of Ecuador. Arch Environ Health 2003; 58
United States Environmental Protection Agency (USEPA). Protect yourself from pesticides: guide for pesticides handlers
. Washington: EPA; 1993.
Recena MC, Caldas ED, Pires DX, Pontes ER. Pesticides exposure in Culturama, Brazil - knowledge, attitudes, and practices. Environ Res 2006; 102
Ibrahim K, Abdel-Ghafar M. Estimation of the social and economic state of the family. In: Sackellares JC, Berent S, editors. Psychological disturbance in Epilepsy
. Boston: Butterworth-Heinemann; 1990. 125-141.
Lorenz AN, Prapamontol T, Narksen W, Srinual N, Barr DB, Riederer AM. Pilot study of pesticide knowledge, attitudes, and practices among pregnant women in northern Thailand. Int J Environ Res Public Health 2012; 9
Badawy MI. Use and impact of pesticides in Egypt. Int J Environ Health Res 2010; 8: 223-239. Available at: http://www.tandfonline.com/doi/abs/10.1080/09603129873507
. [Accessed April 2014].
El Zanaty F, Way A. Background characteristics of respondent. Employment status [chapter 3]. In: Egypt Demographic and Health Survey
2008. Cairo, Egypt: Ministry of Health, final report.
Ecobichon DJ. Pesticide use in developing countries. Toxicology 2001; 160
Konradsen F, van der Hoek W, Cole DC, Hutchinson G, Daisley H, Singh S, Eddleston M. Reducing acute poisoning in developing countries - options for restricting the availability of pesticides. Toxicology 2003; 192
Yassin MM, Abu Mourad TA, Safi JM. Knowledge, attitude, practice, and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip. Occup Environ Med 2002; 59
Nalwanga E, Ssempebwa JC. Knowledge and practices of in-home pesticide use: a community survey in Uganda. J Environ Public Health 2011; 2011: 230894, Available at: http://www.hindawi.com/journals/jeph/2011/230894
. [Accessed April 2014].
Zyoud SH, Sawalha AF, Sweileh WM, Awang R, Al-Khalil SI, Al-Jabi SW, Bsharat NM. Knowledge and practices of pesticide use among farm workers in the West Bank, Palestine: safety implications. Environ Health Prev Med 2010; 15
Ajayi OC, Akinnifesi FK. Farmers′ understanding of pesticide safety labels and field spraying practices: a case study of cotton farmers in northern Côte d′Ivoire. Sci Res Essays 2007; 2
Ribeiro MG, Colasso CG, Monteiro PP, Pedreira Filho WR, Yonamine M. Occupational safety and health practices among flower greenhouses workers from Alto Tietê region (Brazil). Sci Total Environ 2012; 416
Damalas CA, Hashemi SM. Pesticide risk perception and use of personal protective equipment among young and old cotton growers in northern Greece. Agrociencia 2010; 44
Hashemia MS, Hosseini SM, Damala CA. Farmers′ competence and training needs on pest management practices: participation in extension workshops. Crop Protect 2009; 28
Mekonnen Y, Agonafir T. Pesticide sprayers′ knowledge, attitude and practice of pesticide use on agricultural farms of Ethiopia. Occup Med (Lond) 2002; 52
Zhang H, Lu YL. End users′ knowledge, attitude, and behavior towards safe use of pesticides: a case study in the Guanting Reservoir area, China. Environ Geochem Health 2007; 29
Silva JM, Novato-Silva E, Faria HP, Pinheiro TM. Pesticides and work: a dangerous combination for the Brazilian agricultural workers health. Ciênc Saúde Col 2005; 10
Yang X, Wang F, Meng L, Zhang W, Fan L, Geissen V, Ritsema CJ. Farmer and retailer knowledge and awareness of the risks from pesticide use: a case study in the Wei River catchment, China. Sci Total Environ 2014; 49-498:172-179.
[Table 1], [Table 2], [Table 3], [Table 4]