ปัญหาสุขภาพ เกษตรกร

๑. การบาดเจ็บ ทั้งฉับพลันและ เรื้อรัง ๒. โรคระบบการหายใจ ๓. การได้รับพิษสารเคมี การเกษตร ๔. โรคมะเร็ง ๕. โรคผิวหนัง

ปัญหาสุขภาพเกษตรกร ๖. การติดเชื้อ ๗. การเสื่อมการได้ยิน ๘. ปัญหาสุขภาพจิตและระบบ ประสาท ๙. ความผิดปกติของกล้ามเนื้อ และข้อ ๑๐. ภยันตรายจาก สภาพแวดล้อมกายภาพ

AGROTOXICOLOGY A Huge Problem of the Third World Countries Surajit Suntorntham, M.D. Division of Medical Toxicology Department of Medicine Pramongkutklao College of Medicine

Developing Countries Third World Countries > 50% of population is involved in agriculture & farming.> 50% of population is involved in agriculture & farming. Agrochemical: improvement in the financial investment of the farmerAgrochemical: improvement in the financial investment of the farmer –Improve crop production –Minimize losses to pests

Agricultural Chemical Exposures Fertilizers Pesticides Fumigants Miscellaneous

What is a PEST? A pest is anything that competes, injures, spreads disease, or annoys humans, domestic animals, wildlife, or desirable plants. destroys structures or possessions. include insects, insect-like organisms, microbial organisms, weeds, mollusks, and vertebrates.

What is a PESTICIDEs? Pesticides have been defined as any materials formulated or manufactured to kill a pest. –Insecticides- Miticides- Fungicides –Bactericides- Herbicide- Molluscicides –Nematocides- Rodenticides

Report Case of Pesticide Poisoning by Year, Thailand

Insecticides 4 main chemical groups Synthetic organic chemicalsSynthetic organic chemicals Inorganic chemicalsInorganic chemicals BiologicsBiologics BotanicalsBotanicals

Insecticides 4 main chemical groups Synthetic organic chemicalsSynthetic organic chemicals –organophosphates –carbamates –organochlorines

Insecticides 4 main chemical groups Inorganic chemicals:Inorganic chemicals: –metals: arsenic, thallium –cyanide

Insecticides 4 main chemical groups BiologicsBiologics –pheromones –bacteria, viruses BotanicalsBotanicals –pyrethrins

Proportion (%) of Pesticide poisoning by Type of Chemical, Thailand, 1998

Proportion (%) of Pesticide Poisoning by Occupation, Thailand, 1998

2 categories of victims exposed to pesticides Occupational Nonoccupational

Occupational Exposure Mixers, loaders & applicators –acute exposure to high concentrations of pesticides at full strength –illness usually evolved from accidental spills Other field workersOther field workers –exposed to pesticides residues –chronic, low dose exposure - dermal absorption

Report Case of Pesticide Poisoning by Age-Group, Thailand, 1998

Non-occupational Exposure ChildrenChildren –esp. < 10 years old ConsumersConsumers

Proportion (%) of Pesticide Poisoning by Place of Treatment, Thailand, 1998

Proportion (%) of Pesticide Poisoning by Municipality, Thailand, 1998

Measures to Prevent Farm Poisoning Primary Prevention SOURCES PATHWAYS RECEPTORS Engineering Education Enforcement

Measures to Prevent Farm Poisoning Primary Prevention Source : Reduced use of toxins by Engineering :Engineering : –Improved Agriculture Biotechnology (IABT) –Integrated Pest Management (IPM) Enforcement : Regulation by LawEnforcement : Regulation by Law Education :Education : the choice of appropriate types of pesticide, causing as little harm as possible to everything except the pest.

Measures to Prevent Farm Poisoning Primary Prevention Integrated pest management (IPM) the combination of pest control measures into a strategic plan to reduce the damage from the pest to an acceptable level.the combination of pest control measures into a strategic plan to reduce the damage from the pest to an acceptable level.

Integrated Pest Management : IPM Accurate identification the pest(s) –the important step in an effective pest management The knowledge about the pest and the factors influencing development and spread of the pest –helps to manage the pest easily, effectively and successfully. The measures, used to control the pest –Biological control- Cultural control –Host resistance- Mechanical control –Sanitation- Chemical (pesticide) control

Measures to Prevent Farm Poisoning Primary Prevention Pathways : (3E) protection by Distance : –Modification of equipment used that the worker is far away as possible from the pesticide Time –Limitation of working hours Change of working method –Closed mixing and loading systems

Measures to Prevent Farm Poisoning Primary Prevention Education : Safety Programs for Farmers The choice of appropriate types of pesticide –causing as little harm as possible to everything except the pest Toxicity of chemical used & routes of absorption Managing of concentrated & formulations Methods of use & cleaning of equipments Precaution to be taken

Safety Programs for Farmers Strict adherence to pesticide labeling Use of proper personal protective equipments Use of proper tools for applying pesticides Reentry times after applying pesticides.

Safety Programs for Farmers Maintenance of PPE Avoidance of contamination of food, water supplies and other items Early symptoms of poisoning, first aid measure, and transportation of the victim exposed to pesticides

Personal Protective Equipment (PPE) Devices worn to protect the body from direct exposure to pesticides or pesticide residues. –Protective suits- Aprons –Eyewear- Headgear –Respirators- Gloves- Footwear. Pesticide users should follow all PPE instructions that show in the labeling. Heat Stress Precaution.

Mixing, Loading and Application The most hazardous phase of the use of pesticide. Well-ventilated area far from other items that might be contaminated, especially water source. Wear the personal protective equipment that the pesticide labeling requires Apply backing into the untreated area, away from where the pesticide is being released.

Mixing, Loading and Application Delivering the pesticide only to the target site Checking the delivery rate & appearance Avoiding non-target surfaces & organisms Operating equipment safely.

After finishing the application The containers should be rinsed and returned to the pesticide storage area as soon as possible. The empty pesticide containers should be flattened, broken, or punctured, and disposed in accordance with labeling direction.

Measures to Prevent Farm Poisoning Primary Prevention Closed-system product & equipment designsClosed-system product & equipment designs Strict adherence to pesticide labelsStrict adherence to pesticide labels Proper protective clothing when using toxic chemicalsProper protective clothing when using toxic chemicals Child safety emphasis.Child safety emphasis.

Measures to Prevent Farm Poisoning Secondary Prevention โรคเป้าหมายนั้นต้อง เป็นปัญหาใหญ่เพียงพอในกลุ่ม ประชากร ที่ทำให้ผลการตรวจ คัดกรองนั้นเชื่อถือได้ เป็นที่เข้าใจถึงธรรมชาติการ ดำเนินของโรคนั้นแล้วเป็นอย่าง ดี และมีระยะปลอดอาการนาน ก่อนเริ่มแสดงอาการ

Measures to Prevent Farm Poisoning Secondary Prevention โรคเป้าหมายนั้นต้อง มีหลักฐานยืนยันว่า การตรวจพบ โรคนั้นตั้งแต่ระยะต้น ทำให้มี ผลลัพธ์ต่อสุขภาพดีขึ้นกว่าการ ตรวจพบเมื่อมีอาการ – มีการรักษาที่ได้รับการพิสูจน์แล้วว่ามี ประสิทธิผล มีวิธีการตรวจคัดกรองที่แม่นยำ

Measures to Prevent Farm Poisoning Tertiary Prevention Educated farmers and related person about first aid and lifesaving in emergency situationsEducated farmers and related person about first aid and lifesaving in emergency situations Improved rural health access to primary care physicians trained in agricultural medicineImproved rural health access to primary care physicians trained in agricultural medicine The curriculum for training primary care physician should be much more emphasized on agricultural medicineThe curriculum for training primary care physician should be much more emphasized on agricultural medicine

Important Considerations for Transportation of Poisoned Farm Victims Avoid rescuer contamination & poisoningAvoid rescuer contamination & poisoning Maintain ABCsMaintain ABCs Follow vital signsFollow vital signs Initiate decontaminationInitiate decontamination –Remove victim from source of exposure –Remove any contaminated clothing –Irrigate & wash with soap and copious water

Important Considerations for Transportation of Poisoned Farm Victims Identify source of chemical exposure; collect label if availableIdentify source of chemical exposure; collect label if available Optimize transportationOptimize transportation Wear protective clothingWear protective clothing

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