1. Wb-eases&decrgvinaoh-coeh Characteristics of agricultural production techniques in the mekong delta: a medical survey Research project on “Poverty and pesticide use in Vietnam” Research Institution: Center of Occupational and Environmental Health of the Vietnam Association of Occupational and Environmental Health Hanoi-2004

2. A. Introduction Vietnam is an agricultural country with more than 70% of the population working in agriculture. In Vietnam, like in many other developing countries, pesticides are used widely to boost agricultural production and this results in considerable problems to human and Environmental Health Besides adverse effects due pesticide overuse, farmers often misuse these chemicals, do not follow the safe handling procedure, apply these toxic chemicals excessively or in ineffective ways. The results are environmental pollution and damages to the health of farmers themselves

3. B. objectives 1. General objective: - Evaluation of frequency of pesticide hazard in poor farmers and in the general farming population - Health impairments attributed to pesticide use in poor farmers and non poor farmers 2. Specific objectives: 2.1. To evaluation the risk factors, hazard and knowledge of pesticide use of farmers in two groups: - Poor farmer group - Non poor farmer group 2.2. To assess working condiction of famers exposed to pesticides and work-related diseases such as skin diseases, pesticide poisoning etc.

4. c. Method and materials 1. Study sites and subjects: 1.1. Study site 10 Communes of 10 Districts of 5 Provinces in Mekong Delta 1.2. Subjects 600 farmers (Male and Fermale) exposed to pesticide (spraying, storing, mixing...pesticides) 2. Methods: Across-sectional study was conducted. The data selection include: - Medical survey questionnaires: 600 farmers - Medical examination: All the 600 farmers - Medical tests: Blood test and skin test

5. Blood test The Cholinesterase enzyme test was carried out to diagnose and to detect individuals suffering from pesticide poisoning (Organophosphate and Carbamate) 150 farmers (Poor and non-poor) were selected for this test based on reported symptoms and signs of pesticide poisoning such as headache, nausea, tiredness, saliva secretion, dizziness, dim eyes, shortness of breath, tear streaming, muscle weakness or covulsion... Cholinesterase enzyme test technique: Measurement of active cholinesterase enzyme (AchE) in erythrocyte and plasma, using 0.4 ml blood from fingertip for analysis (Sampes were analysed at the Central Medical Laboratory of Tien Giang province (Follow: The technical manual on Occupational and Environmental health of Vietnam, 1993)

6. Skin test - Patch-skin test was used to diagnose persons suffering from pesticide contact dermatitis (irritant contact dermatitis and allergic dermatitis). - 200 farmers (poor and non-poor) were selected for the patch test based on symptoms and signs of contact dermatitis such as prurigo, skin itching, skin ulcer, dermatitis, eczema etc. - Patch-skin test technique: Following the procedure of the International Contact Dermatitis Research Group (ICDRG): Put 0.1-0.2ml (gr) into a chamber of Leuko test or Al test Attach the tests on the patient’s upper back or forearm and keep it there for a minimum of 6 hours to see the reaction. Interpretation of results:. Negative reaction (-). Weak reaction : (+) erythema, infiltration, possible papules.. Strong reaction (++) edematous or vesicular.. extreme reaction ( +++ ) Spreading, bullous. Irritant reaction (IR).

7. D. Results Table 1: Distribution of famers in the study in 10 communes in the Mekong Delta ProvinceProv. code DistrictCommuneCom. code Interview, Cli.nical examination Skin test Blood test An Giang1An Phu Chau Thanh Vinh Hau Binh Hoa 1212 66 60 18 17 Can Tho2Vi Thanh Thot Not Vi Tan Thanh Thang 3434 62 61 26 27 24 16 Long An3Tan Thanh Thu Thua Nho H Lap Nhi Thanh 5656 63 17 20 17 19 Tien Gian4Cai Lay Cho Gao My T Nam Thanh Binh 7878 60 26 22 20 Tra Vinh5Tra Cu Tieu Can An Q Huu Ngai Hung 9 10 66 65 21 19 20 19 Total10 626214190

8. Table 2: The rate of famers in two survey ProviceProv.cod e DistrictCommuneCom. code Number of subjectsMatched cases W.BNov. survey Decem. survey Matched number Matched rate An Giang1An PhuVinh Hau160 664575.00 Chau ThanhBinh Hoa260 615388.33 Can Tho2Vi ThanhVi Tan360 624676.56 Thot NotThanh Thang460 615083.33 Long An3Tan ThanhNhon Hoa Lap 560 634676.66 Thu ThuaNhi Thanh 66061634675.40 Tien Giang 4Cai LayMy Thanh Nam 760 4880.00 Cho GaoThanh Binh 86062605182.25 Tra Vinh5Tra CuAn Quang Huu 960 655286.66 Tieu CanNgai Hung 1060 654981.56 Total10 60060362648680.59

9. Table 3: General information General informationPoorNon - PoorTotal n%n%n% Age (year) <2051.6120.6371.12 21 - 304012.904313.618313.26 31 - 4011035.4810031.6521033.55 41 - 507825.169429.7517227.48 >507724.847724.3715424.60 Total31049.531650.5626100 Height (cm) < 150103.2310.32111.76 150 - 16011336.459429.7520733.07 160 - 17016352.5818357.9134655.27 >170247.743812.03629.09 Total31049.531650.5626100 Weight (kg) <4020.6530.9550.80 41-5010533.876620.8917127.32 51-6016452.9015850.0032251.44 >603912.588928.1612820.45 Total31049.531650.5626100 Education level No schooling61.9430.9591.44 Primary12440.008426.5820833.23 Secondary12239.3513643.0425841.21 High school5818.719128.8015023.96 Others00.0020.6320.32 Total31049.531650.5626100

10. Table 4: Health and Pesticides Health & pesticides informationPoorNon-poorTotal n%n%N% Symptoms after contact with pesticides Eye irritation14250.214149.828345.2 Fever4850.04850.09615.3 Headache17049.117650.934655.3 Convulsion1365.0735.0203.2 Dizziness15351.014749.030047.9 Shortness of breath10751.010349.021033.5 Vomiting4143.65356.49415.0 Skin irritation17648.418851.636458.1 Diarrhea1441.22058.8345.4 Other14246.716253.330448.6 Tota626100

11. Table 5: Medical examination DiseasesPoorNon-poorTotal n%n%n% Respiratory diseases 60.9650.80101.8 Cardio-vascular 355.53355.537011.2 Skin diseases 10316.41322112437.4 Nervous diseases 10.15001 Urinary diseases 0020.312 Digestional diseases 30.4850.8080.56 Other diseases 10.1520.3130.46

12. Table 6: skin test Table 6: skin test Skin testPoorNon-poorTotal n%n%n% Negative reaction7351.46948.614266.4 Positive reaction3447.23852.87233.6 Table 7: Reaction level of skin test Reaction levelPoorNon-poorTotal n%n%n% Positive reaction3447.23852.87233.6 Weak reaction3441.54858.58238.3 Strong reaction2553.12246.94722.0 Extreme reaction000000

13. Table 8: Skin test of pesticide types Pesticide types Weak reaction Strong reaction Extreme reaction Total n%n%n%n% Carbamate3268.11531.90047100 Organo- Phosphate 3062.51837.50048100 Pyrethroide 2058.81441.20034100

14. Table 9: Blood test results Reaction levelPoorNon-poorTotal n%n%n% Normal6149.66250.412364.7 Poisoning3450.73349.36735.3 Total9550.09550.0190100

15. Table 10: Levels of pesticide poisoning Test results PoorNon-poorTotal n%n%n% Poisoning3450.73349.36735.3 Acute poisoning1242.81657.12841.8 Low acute poisoning 950.09 1864.3 High acute poisoning 330.0770.01035.7 Chronic poisoning2256.41743.63958.2

16. E. Conclusion The medical survey on pesticide use, hazards and health impact was conducted in 10 communes in 5 provinces of the Mekong Delta in Vietnam. From the results shown above, we can make some conclusions as follows: In Vietnam, like many other agricultural countries, pesticides are used more and more to prevent insects and to increase agricultural production.

17. Conclusion At present, the pesticides mostly used in Vietnam and in the Mekong Delta are carbamates, organophosphates and pyrethroides which occupy from 85% to 95% of all the amount of pesticides used The skin disease rate of subjects exposed to pesticide was 37.50%, the prevalent rate of cardio-vascular diseases was 11.20%, respiratory diseases was 1.80% and other diseases was 2.23%.

18. Conclusion The positive reaction of skin test was 33.60% and the strong reaction was 22%, there was not any case of extreme reaction. The rate of positive reaction of skin test in the poor group was 47.20% and non-poor group was 52.80%. Therefore, we had not yet found any statistical difference of skin diseases between the two groups (p = 0.562 ). The pesticide poisoning rate was 35.30%, among them, the chronic poisoning was 58.20% and the acute was 41.80%.

19. Conclusion The pesticide poisoning rate of the poor group was 50.70% and the non-poor group was 49.30%. There was not statistical difference of pesticide poisoning between the poor group and non-poor group ( p = 0, 879 ). The results obtained from this survey showed that the skin diseases rate was 37.50% and the pesticide poisoning rate was 35.30%, these were high rates. These results showed the relationship between cause and effects of the pesticide use and health consequences.

20. F. Recommendations To promote the education of pesticide use to every farmer by many ways such as media, posters, brochures, training courses and leaflets. To systematize guidance document as well as the methods of close management of pesticide business license, production and distribution. The medical periodic examination for exposed to pesticides need to be properly considered. Next step, it would be highly appreciated if the World Bank could support a medical survey in the Red River Delta.