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Patterns of agrochemical handling and community response in central Kenya.

As in any other agricultural country, pesticides and fertilizers are the primary agrochemicals used by farmers in Kenya. The farmer uses these agrochemicals to control organisms that destroy crops and infest livestock (1). In addition, fertilizers are needed to replenish soil nutrients and consequently improve the agricultural yield. The public health sector uses pesticides to combat insects and vectors that transmit diseases to humans and animals (2).

Although Kenya's economy is dependent on agriculture, only a third of the land is arable. Enormous amounts of the agrochemicals are imported and extensively used every year. For instance, between 1985 and 1987, Kenya imported agrochemicals worth 1,732.3 million Kenya Shillings (U.S. $69.3 million). Although they are intended to kill pests, these chemicals have accidently and intentionally caused many deaths. A recent study estimated that of the five million people in the agricultural sector of Kenya, 350,000 (7 percent) are poisoned by pesticides annually, at an annual economic impact of Ksh.336 million (US $11.2 million) (3). Because of their toxic effects, these agrochemicals need to be handled carefully and according to the instructions on the container's label (4, 5).

Risk factors of agrochemicals

The major causes of agrochemical poisoning in Kenya stem from unawareness of the risks of agrochemicals, illiteracy, lack of instructions on the agrochemical containers, failure to use protective clothing and re-use of the empty containers to store edibles (6). Equally important are poisoning due to occupational accidents, homicide and suicide attempts (6).

Agrochemicals commonly associated with acute exposure for suicidal motives include gamatox, an acaricide, and diazinon, an insecticide of the organophosphate group. Gamatox is commonly used by the rural community to dip livestock to against ticks, while diazinon and baygon are used as common insecticides. The latter, an organophosphate compound containing propoxur, is toxic. Killtox |R~ (Pyrethroids), less harmful than organophosphate, is widely available in spray form as an insecticide (4).

While all agrochemicals are potentially dangerous, the motive and the dosage determine the effects of the toxicity to human life. Both acute and chronic poisoning were apparent in some of the community members. In 1976, for example, the National Local News Paper reported an incident where a family in South Nyanza lost a daughter after she drank an insecticide, having mistaken it for an antacid. In 1988, a similar incident occurred where three children in Embu, in the eastern part of the country, died after they accidently mixed wheat flour with pesticide powder to harden dough for home baking. There are many more incidents of this kind which are not reported.

Accidental poisoning can be minimized at the community level by educating the farmers about effective use and safe methods of handling agrochemicals (6, 7).

Objectives of the study

The study had several objectives:

* to assess the community's knowledge, attitudes and behavior related to handling of agrochemicals;

* to identify the types of agrochemicals used in the community;

* to observe the handling practices if mixing, spraying and storage;

* to identify health complaints related to handling of these agrochemicals;

* to develop a public health education program and disseminate information on safe handling of agrochemicals using the community as the main participant.

This approach made the study unique because previous studies in Kenya emphasized the clinical aspects of agrochemical poisoning, rather than community-based methods which emphasize intervention aspects. Meme et. al found elevated levels of mercury in the blood and chronic mercury poisoning of farmers and their families (8). Moreover, the study by Kanja et. al showed the presence of organochlorine in human breast milk (9). In 1986, 732 cases of agrochemical related poisonings were treated at the Kenyatta National Hospital, an average of two cases of pesticide poisoning per day (10).

TABULAR DATA OMITTED

Methods

The study area

The study was conducted in the rural community of Githunguri location, Kiambu district, approximately 50 kilometers northwest of Nairobi. A location refers to a small administrative unit in Kenya, headed by a chief. It is divided further into sub-locations, with an assistant chief heading each sub-location. Each sub-location is further arbitrarily divided into villages and, the smallest unit, households.

The small-scale farmers use fertilizers, fungicides and pesticides among other chemicals to get higher agricultural yields from small and over-cultivated land. Coffee and tea are the chief cash crops, while maize, potatoes, vegetables and various horticultural crops such as fruits, flowers and ornamental plants are grown for consumption and retail. These crops are marketed to Nairobi and other local towns.

Selection of sample population

The sample population was composed of all households in the six sub-locations of Githunguri location. A complete census of all households was done with the assistance of the local community members. Villages were considered as clusters and households within these villages as listing units. Ten villages were randomly selected from the 34 villages in the location, using cluster sampling with probability proportional to the number of listing units (households) in the cluster. This sampling procedure was selected not only because the clusters had an unequal number of listing units, but also to improve reliability of estimates. For statistical purposes, the minimum number of households needed was calculated as 288, but the study covered a sample of 1,797 households.

Community involvement

Prior to data collection, exploratory visits were made to establish rapport with the community. The nature, purpose, importance and community's role in the research were explained to the leaders and community at large. The leaders were identified as the key administrative persons (i.e., the chief and assistant chiefs), informal leaders (such as school head teachers), District Health Management Teams (DHMTs), agricultural extension field workers, livestock and water development workers, church leaders, coffee factory leaders, business community and women leaders, and open market small-scale traders.

School and church systems became the vehicle for communication to the rest of the community. Whenever there was a need to call a community gathering (baraza), church leaders announced this to the congregations, who in turn informed their relatives, friends and neighbors. School headmasters made announcements at school assemblies and the children relayed the message home to their parents and other community leaders.

Recruitment and training research assistants

With the assistance of school teachers and the local administration, reliable high school students were identified, recruited and trained as research assistants and guides. The criteria for selection for these individuals were good academic standing and familiarity with the arbitrary village boundaries. Five of the best qualified persons were hired as research assistants for a period of 18 months, while two other research assistants from each village were hired temporarily to act as village guides. The research team was composed of five research assistants, two guides and the two principle investigators.

The only criteria for the respondents was household membership, preferably the head of household. If the head of household was absent, the spouse was interviewed when possible. If neither was present, the oldest child (at least 15 years old) was interviewed. The data were collected using a structured questionnaire which consisted of 28 questions. Prior to data collection, the questionnaire was pre-tested and revised. It was administered in the vernacular language. Observations were made to assess the patterns related to the handling practices. Some random samples of unknown agrochemicals were collected and forwarded to the National Public Health Laboratories for analysis. Chromatography method was used to establish the chemical's authenticity.

Analysis of the data was by descriptive and chi-square statistics. Because education is universally used to determine the public's knowledge, attitudes and practices with respect to handling agrochemicals, the relationship between level of education and the patterns of agrochemical handling was assessed using a chi-square test statistic (11).

Results

The community's cooperation and moral support proved to be an invaluable asset. For instance, the schools offered classrooms to be used during training of research assistants. Two health centers offered facilities as our daily operational bases, and for storing questionnaire forms, data and other equipment.

One member from each of 1,797 families was interviewed. Approximately three quarters of the families surveyed owned less than five acres of land. Age distribution of the respondents ranged from slightly under 15 years to just above 55 years of age. Eighty percent of the respondents were either the head of household or the spouse. The oldest children of the households represented another 12 percent of the respondents. Less than five percent of the respondents were either widowed, separated or divorced. Among the heads of households, 59 percent were employed in either government or private sector, while 41 percent were self-employed.

Ninety-nine samples of unknown agrochemicals were randomly collected. Of these samples, 68 percent were found in secondary containers. Laboratory analysis showed that they represented only 29 chemicals (the rest were mixtures of some chemicals). They were categorized as fertilizers, fungicides, insecticides, herbicides, nematocides and rodenticides.

More than 62 percent of the respondents stored agrochemicals in the living quarters, although they appeared to be aware of the dangers posed by the agrochemicals and stored them out of reach of children. Only 24 percent claimed they took precautions all the time, whenever they handled any type of agrochemicals, while 69.4 percent claimed they took precaution only while handling some of the chemicals. The rest of the respondents (6.6 percent) said they did not take any precautions at all when handling any chemicals. The relationship between the level of education and consideration of precaution while handling agrochemicals was statistically significant.

When asked to read the instructions on an agrochemical container label, 60 percent of the literate respondents admitted that the instructions were too technical for them to comprehend, despite their ability to read them. Due to this difficulty, it was discovered that the community had developed vernacular names for some of the agrochemicals. These names were coined according to the local concept of smell, color, or target pest. A selection of some of the common vernacular names is given in Table 3.

Overall, the relationship between the level of education and the preparation of agrochemicals according to the instructions was significant. Similarly, the relationship between the level of education and use of protective clothing while spraying the chemicals was statistically significant.

The common health related complaints believed to be related to agrochemical exposures was sneezing, difficulty in breathing, TABULAR DATA OMITTED skin abnormalities, nausea and vomiting (Table 6). During the study period (1987-1990), 133 cases of agrochemical poisoning were seen at the main local (District) hospital. Fifty-seven percent of these cases were of undetermined causes, while 35.5 percent were suicide attempts. The remaining 7.9 percent were of accidental causes. About 90 percent of these poisonings were from organophosphate pesticides (10).

Discussion

Results show there is an increasing need for agrochemical use in the community. Despite this need, knowledge, attitude and practices regarding safe handling of agrochemicals was shown to be low. For example, the majority of the families stored the agrochemicals in their living quarters. Apparently they were unaware of the dangers of inhaling the dust or particulates from these chemicals. Long time exposure to some agrochemicals has potential to cause both acute and chronic health effects (12). It is possible that these chronic effects will show up in some of the community members at a later time. In this community, there were incidences of acute poisoning. most of which were incidences of acute poisoning. At times, these incidences rendered medical intervention helpless. The investigators were unable to verify reports related to pesticide suicide attempts.

The community's concept of precaution involved many different things, such as the respondent's wearing old rags (in order not to soil good shirts and dresses), covering one's mouth with an old handkerchief, or a knitted headgear popularly known as "rastas caps" by the youth.

Reasons for not wearing protective clothing were poor, such as "nobody else wears the protective clothing;" no reason or no need to wear them; and so on. Some of the more realistic reasons were that the protective clothing were both expensive and uncomfortable. One teenage farmer answered, "You cannot work in equatorial climate when dressed like an astronaut." Another respondent claimed that he wold rather work without those "astronaut cloth-like uniforms" because they make him feel as if he was in an oven and that the clothing slowed his rate of spraying.

Studies have confirmed that many of the agrochemicals are well absorbed by dermal route (13, 14). Since 66 percent of the respondents did not wear protective clothing, this may be the explanation for sneezing, difficulty in breathing and contact dermatitis which were experienced by the respondents. Some of the young women working in the coffee factories were either pregnant or had nursing babies. Failure to use protective clothing may have exposed them to agrochemical levels sufficient enough to trigger spontaneous abortions or cause malformations of the unborn fetuses. Nursing babies could have been exposed to some of these chemicals; for example, organochlorine pesticides which readily find their way from blood to women's breast milk (9).

Some of the agrochemicals have been shown to have carcinogenic, mutagenic and teratogenic effects (12, 15). Given this kind of exposure, it is possible for such manifestations to occur in some of the community members and probably their offspring. Because of the possible resultant health effects, the Ministries of Health and Agriculture should work together in educating the community on the importance of wearing protective clothing whenever they handle agrochemicals. This would minimize the amount of exposure that would cause both acute and chronic health effects.
Table 3
Pesticides used and popular local names
Pesticide Trade name Kikuyu name Used as
DDT Dawa(*) ya thuya Insecticide
Malathion Marathioni Insecticide
Cabofuran Furadan Dawa ya igunya Fungicide
Copper Kopa Fungicide
Fenitrition Dathion Ndithani Fungicide
Carbaly Dawa ya nguha Insecticide
Captafol Difolatan Gitono Fungicide
Orthodifolatan Difolatan Dawa ya mbaa Fungicide
Diazinon Diazol Dawa ya ria Herbicide
* "Dawa" (medicine) and "muthaiga" (medicine) were used
interchangeably


Since about 70 percent of the agrochemical samples collected were in the secondary containers, identifying the chemicals proved to be a difficult exercise. Having the agrochemicals in secondary containers meant that the containers no longer had instruction labels on which the farmers could rely. However, the users regarded this as only a small inconvenience, since they claimed they knew both the TABULAR DATA OMITTED source and intended target.

As previously mentioned, the farmers preferred to use the popular vernacular names. Information about the meaning of these names revealed a rich application of symbols in the local dialect. Some of these were the trade names pronounced in the Kikuyu language, while others were based on the smell, color or other unique characteristic of the chemical. The following are examples illustrating the hidden or symbolic meaning. The Swahili word "dawa," or the Kikuyu equivalent "Muthaiga," can mean medicine or poison interchangeably, depending on the target and the motive. For instance, "dawa ya ria" simply means poison for killing weeds. The same phrase could be used at the same time to refer to herbicide, insecticide, fungicide or pesticide. The fungicide Captafol, marketed under the trade name difolatan, is known in the community as "Gitono" (foul smell). "Gitono" is the Kikuyu name of an insect that releases a horrible smell when disturbed. Captafol is not targeted to kill; rather, its smell is similar to that which is released by the insect.

The community's ingenuity in some of these local names appeared accurate in distinguishing between the various agrochemicals. The use of vernacular terminology and phrases was encouraged by the workshop participants, most of whom were residents of the community.

Education was an important determinant of behavior related to handling of agrochemicals. It is therefore worth mentioning here that formal and informal education would significantly help farmers and the public to understand the importance of proper storage of agrochemicals, use of protective clothing, and the essence of following the container label instructions. This knowledge would greatly minimize the incidences of agrochemical poisoning due to suicide attempts, accidental and occupational exposures.

Potential confounders

Like any other studies, it is possible that there were some confounding factors which perhaps biased some of the study findings. First, questions were self-reported and subjective. As such, they may have introduced some bias into the study. For example, some of the agrochemical self-reported complaints (sneezing, coughing, difficulty in breathing, etc.) could have been due to a variety of environmental factors and personal behaviors, such as smoking. Given this understanding, it is possible that some of these reported health complaints were not specifically caused by the agrochemicals. Secondly, data were not available to show the incidence of the health conditions among those who handle agrochemicals and those who do not.

Health education workshop

Following the end of the study, a one week workshop was organized in a local hotel. The objectives of the workshop were to report the findings of the study to the community representatives and to work with them to develop an intervention program. The main purpose of the intervention program was to address the gaps in the public's knowledge, attitudes and practices regarding safe handling of agrochemicals. A cross-section of the community was invited to participate.

Recommendations from the workshop were used to develop an intervention program. The following are the participants' recommendations:

* Warning on agrochemicals should read "Keep away from reach of human beings and animals."

* Pesticides should be packaged in smaller containers in order to minimize opportunities for unlicensed retailing.

* Manufacturers should familiarize themselves with local popular names, which are familiar to the farmers, in addition to official trade names.

* Coffee factory workers engaged in distributing agrochemicals to the farmers should set good examples by wearing protective clothing.

* A Public Health Act should be passed by the Kenya government to ensure and regulate proper handling and disposal of empty agrochemical containers, use of protective clothing, and prosecution of unlicensed agrochemical dealers.

* Casual laborers at the coffee factory chemical stores should be provided with effective protection from chemical exposures.

* Butcheries should be encouraged to improve cleanliness instead of spraying meat with insecticides to kill house flies.

* Use of domestic containers, soda bottles and brown bags for packing agrochemicals should be discouraged.

* Containers used for mixing and storing spraying pesticides should not be used for any domestic purpose.

* To avoid contamination of human food, grocers should not be licensed to sell agrochemicals.

* To avoid exposing office workers, storage of chemicals at the coffee factories should not be located near the administrative and personnel offices.

* Career sprayers should be provided with water and soap for washing after spraying.

* The Kiambu County Council should improve garbage collection and drainage systems to reduce the use of chemicals for rodent and fly control.

* Consumers should be discouraged from purchasing freshly sprayed vegetables and fruits. They should wash all farm produce TABULAR DATA OMITTED thoroughly before cooking or consuming.

Due to time and financial constraints, modalities of the dissemination of the health education were launched in phases. Several posters were produced and distributed to health educators and schools for illustration during the health education talks.

It was encouraging to see the enthusiasm with which the local authority, opinion leaders and the public in general took up the matter. Local youth were dispatched to pin the posters at strategic places in the health centers, market places, school notice boards, enquiries offices in various factories, administration centers and other public places. While the dissemination of information related to safe handling of agrochemicals was being carried out, the researchers learned that the chief had banned the sale of agrochemicals by unlicensed dealers in the open air market because of their proximity to human food. The District Health Management Team has integrated the messages on safe handling of pesticides with their regular health education teachings to the community. For example, health care workers are disseminating the messages to patients as they wait for services at health centers.
Table 6
The most common health complaints presented by the respondents
Illness No. of responses Percentage
Sneezing 980 54.5
Breathing difficulties 640 35.6
Skin abnormalities 211 11.7
Nausea, vomiting 300 16.7
Total 2,431
Note: The percentage does not add up to 100 due to response of
multiple complaints.


During these sessions the investigators were convinced that the community as self-motivated to continue and sustain the intervention programs. Safety in agrochemical handling remains the responsibility of the community. Without the community's concerted efforts to help themselves, any input of health education by outsiders would be ineffective. Plans are underway to evaluate the community self-sustained program.

References

1. Akhabuhaya, J.L. (1989), Use of pesticides in agriculture, East Africa News Letter on Occup. Health and Safety (3):8-9.

2. Van Heemstra, H.A. and W.F. Tordoir (eds.) (1982), Educational and safe handling in pesticide application, Studies in Environmental Science, Elsevier, New York, NY.

3. Choudhry, A.W. and B.S. Levy (1988), Morbidity estimates of occupational illnesses and injuries in Kenya, KEMRI & KETRI Proceedings of the 9th Annual Medical Scientific Conference, Nairobi, Kenya, Feb. 1-5.

4. Manda, R.B. (1985), Pesticide use by the cash crop farmers in Malawi; pesticides management in Eastern and Southern Africa, Proceedings of a Regional Workshop, Nairobi, Kenya, Mar. 10-15.

5. World Health Organization (1990), Pesticides application equipment for vector control, Twelfth report of the WHO expert committee on vector biology and vector control. Technical Report Series 791, WHO, Geneva, Switzerland.

6. Mwanthi, M.A. and V.K. Kimani (1990), Health hazards of pesticides, World Health Forum: An International J. of Health Development 11(4):430, World Health Organization, Geneva, Switzerland.

7. Mukunya, D.M. (1988), Safe and effective use of pesticides, Proceedings of Pesticides Chemical Association of Kenya Manufacturers-GIFAP Workshop, Nairobi, Kenya, Feb. 11-12.

8. Meme, J.S., J.D. Brown, J. Kagia, B.A. Dawa and W.Kihia (1981), Mercury poisoning as cause of acrodynia in Kenya children, a preliminary report, East African Med. J. 58(9):641-648.

9. Kanja, L., L. Utne Skare, I. Nafstad, C.K. Maita and P. Lokken (1986), Organochlorine pesticides in human milk from different areas of Kenya, J. of Tox. and Environ. Health 19(4):449-464.

10. Mwanthi, M.A. and V.N. Kimani (1990), Agrochemicals: A potential hazard to Kenyan small-scale farmers, paper presented to the IDRC Pesticides Symposium, Ottawa, Canada, Sept. 17-22.

11. Armitage, P. (1987), Statistical Methods in Medical Research, Blackwell Scientific Publications, London.

12. Hardell, L. and A. Sandstrom (1979), Case-control study: Soft tissue sarcomas and exposure to phenoxyacetic acids of chlorophenols, British J. Cancer 39:711-717.

13. Wolfe, H.R., W.F. Durham and J.F. Armstrong (1967), Exposure of workers to pesticides, Arch. Environ. Health 14:622-633.

14. Davies, J.E., V.H. Freed, H.F. Enos, R.C. Duncan, A. Barquet, C. Morgade, L.J. Peters and J.X. Danauskas (1982), Production of pesticides exposure with protective clothing for applicators and mixers, J. of Occupational Med. 24(6):464-468.

15. Reddy, J.K., D.L. Azarnoff and C.E. Hignite (1980), Hypolipidaemichepatic peroxisome proliferators form a novel class of chemical carcinogens, Nature 283:397-398.

Mutuku A. Mwanthi, School of Public Health, Univ. of Texas Health Science Center, 1908 Carroll #1, Houston, TX 77030.
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Author:Kimani, Violet N.
Publication:Journal of Environmental Health
Date:May 1, 1993
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