Since 2008, Brazil has been leading the world ranking of the largest consumer of pesticides in the world. This increasing the risk of poisoning and environmental contamination. This paper's objective is to analyze the use of Personal Protective Equipment (PPE) and the manifestation of signs and symptoms of acute and chronic intoxication in agricultural workers in southern Brazil. This is a field research carried out through semi-structured interviews with 142 family farmers who produce garlic and grapes. The results show that only 17.60% of farmers use all eight recommended PPE. Most participants (90.84%) claim to wear boots, gloves (75.35%) and pants (73.94%). Regarding acute symptoms, 31.69% reported headaches after the pesticide application, 28.16% eye irritation, and 23.94% weakness/fatigue/tiredness. Of the total, 38.02% reported depression, and 35.91% had systemic arterial hypertension. The data set indicates that farmers are exposed to risks due to exposure to pesticides and the inappropriate use of PPE. It is noticed that a high number of workers presented acute symptoms after the use of pesticides. Therefore, it is necessary to raise awareness among farmers about the risks of human and environmental exposure to these products.

Keywords: pesticides; health; intoxications

The use of pesticides has intensified in agriculture in recent decades, resulting in significant impacts on human and environmental health. Pesticides originated in the interim of the world wars, developed by companies producing and formulating chemical weapons. Afterwards, it started to be used progressively for expanding the agricultural market.¹ In Brazil, these inputs were quickly accepted, to the point that, since 2008, it has become the leading country in the world's ranking largest consumer of pesticides,² increasing the risk of poisoning and environmental contamination by these products.

In 2017, Bombardi published an extensive mapping of pesticide consumption in Brazil, demonstrating a growing use (many pesticides are banned in the European Community), the main agricultural products responsible for this consumption (soybeans, corn, and sugarcane alone consume 72% of the pesticides sold in the country) and the regional differences in this consumption (concentrated in the Midwest, Southeast, and South regions of Brazil). It also showed that pesticide consumption increased by 100% between 2000 and 2010 in the world, while in Brazil, this increase was 200%. Further, from 2012 to 2014 about 8.33 kg of pesticides were applied per hectare, with glyphosate being the most consumed in all Brazilian regions.³ This study, together with the Abrasco Dossier,² served as a great warning about the seriousness of the use of pesticides in Brazil and the risks to human and environmental health they pose.

Pesticides are used to control or eliminate insects, larvae, weeds, and other pests that can affect crops.^1,4–6 However, its effects are not selective and generally affect flora and fauna.

Regarding humans, after inadequate exposure to pesticides, there may be intoxication. Effects can be classified into: i) acute effects, or those resulting from exposure to concentrations of one or more toxic agents capable of causing harm within 24 hours after exposure; and ii) chronic effects, or those resulting from continued exposure to relatively low doses of one or more products, which may appear weeks, months, years or generations after their use.^1,2

Pesticides are classified based on their purpose, chemical group, and toxicity. Toxicity is the ability of a chemical to cause adverse effects in living organisms.

In 2019, there was a pesticide toxicological reclassification carried out by the National Health Surveillance Agency (Anvisa), through Resolution No. 2080,⁷ according to the standards of the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). As a result, only those that can cause death if in contact by oral, inhalation, and/or dermal routes are classified as extremely toxic.⁸ This reclassification entails greater risks to the health of rural producers since they do not follow the indications according to the technical package leaflet, in addition to not using the personal protective equipment (PPE) required for application.⁹ The non-use of equipment stems from the thermal discomfort they provide, the high costs they represent to farmers, in addition to the belief shared by many that these substances do not cause harm to health.

The situation is alarming in Brazil, considering the illiteracy in farmers.¹⁰ It is also difficult for health professionals to make an adequate and quick diagnosis of acute poisoning, as well as to establish the causal link between the use of pesticides and chronic diseases such as cancer, depression, and Parkinson's disease, among others.

It is also important to point out that efforts have been made by various segments of society and by pesticide manufacturers to cover up the risks they pose to human and environmental health. However, more and more researchers worldwide have demonstrated the acute effects and chronic diseases resulting from contact with these substances.²

Considering the characteristics of pesticide use in Brazil and the fact that the southern region of Brazil is one of the regions that consume the most pesticides in the country, the present study aims to analyze the use of PPE and the manifestation of signs and symptoms of acute and chronic intoxication in agricultural workers from south of Brazil.

Answering this question can contribute to the search for evidence to clarify the relationship between pesticide exposure and the manifestation of signs and symptoms of acute and chronic intoxication. Data of this nature can be useful for public policies' development that protect farmers, and to assist the health system in defining forms of prevention, early diagnosis, and treatment of this fundamental professional category in providing food to the population.

This is a field research which was carried out through semi-structured interviews with 142 family farmers that produce garlic and grapes in a municipality in Serra Gaúcha/RS/Brazil, which stands out as the largest national producer of garlic. Field research seeks to describe and explore phenomena in natural settings. The purpose of a field researcher is to approach the people studied (in this case, farmers) in order to understand a problem or situation (the use of pesticides) from their natural setting.¹¹

The municipality of São Marcos is located in the Brazilian Serra Gaúcha, on the upper slope of the Northeast region of the state of Rio Grande do Sul (Figure 1). São Marcos, with a subtropical climate, is located 166.1km from the capital Porto Alegre. It lies at an altitude of 746 meters, in a total area of 256.25 km², of which 16.44km² are urban areas. The estimated population is 21,449 inhabitants.¹² Its location can be seen in the following figure.

Figure 1 Location of the municipality of São Marcos in RS.

The interviews were carried out by trained researchers through a script applied directly to the farmers who agreed to participate in the study and who signed the Free and Informed Consent Form (TCLE), according to the precepts of Resolution 466/2012 of the National Health Council.

The sampling unit was defined according to the universe of farmers present in the rural area of the São Marcos. Considering that there are 4000 farmers and a significance level of 95%, p=005, the sampling unit of farmers is 351 ¹³. This is, therefore, partial data, which is part of the Project “The use of pesticides in family farming and its implications for the health of farmers and environmental health” approved by the Research Ethics Committee under number 17010519.1.0000.5341.

For data processing, the statistical program Statistical Package for Social Sciences (SPSS) (version 21.0) was used, with partial data treated by descriptive statistics.

The results are organized into two subsections. The first contains characterization data of the farmers, and the second, data regarding the use of Personal Protective Equipment and the main acute and chronic effects presented by the farmers that make up the sample.

Characterization of the study's farmers

In Table 1 there is the characterization data of the farmers in terms of gender, age group, schooling, and time working in agriculture.

The results show that most of the sample (54% of the farmers) are female, with schooling up to elementary school (66.9% with up to eight years of education) and working time equal to or greater than forty years (Table 1).

The use of PPE and the prevalence of acute and chronic damage

Table 2 below presents the number and type of PPE used by farmers and the acute and chronic damage they perceive or present after use.

The data show that only 17.60% of farmers use all eight recommended PPE for this activity. Most participants (90.84%) wear boots, followed by gloves (75.35%) and pants (73.94%). Only 32.39% of farmers use a face shield. Regarding acute symptoms, 31.69% reported headaches after the pesticide application, 28.16% eye irritation, and 23.94% weakness/fatigue/tiredness. Of all rural workers, 38.02% reported having depression and 35.91% systemic arterial hypertension, as shown in the table below.

This study was carried out with family farmers, which may explain the fact that the female and male genders are in very close numbers, with 54% women and 46% men. Studies carried out with workers in non-family agriculture indicate a greater predominance of men.^14,15 Low schooling can be considered a risk factor, considering that pesticide package inserts contain technical language and that few farmers receive adequate guidance when purchasing inputs.^10,16 The lack of adequate environmental education for farmers and unequal access to education has been evidenced by other authors in Brazil¹⁰ and abroad.¹⁷

Brazilian legislation requires the use of eight personal protective pieces of equipment during the handling of pesticides, which includes the preparation of the syrup, the application, and the harvesting of agricultural products. In the study, only 17.6% of workers claim to use all the equipment, which may increase the risk of acute or chronic poisoning.^18–20 Most farmers claim to wear boots, an Arab cap, and an apron. However, the equipment observed in loco corresponds to improvised clothing, such as caps and aprons, without adequate waterproofing. This is risky behavior, justifiable by the historically produced culture that pesticides are not harmful to health, the inadequacy of equipment in relation to the climate, and the costs of acquiring them. Thus, public policies that provide equipment and facilitate access to education programs are essential for changing behavior.

Among the symptoms most cited by farmers are headache, eye irritation, weakness and fatigue, dizziness, and visual changes, in addition to vomiting and diarrhea, which are sufficiently recognized as related to pesticide exposure.^2,21,22

These acute symptoms are related to changes in the acetylcholinesterase enzyme caused by organophosphates and carbamates, resulting in cholinergic effects in the body. To confirm intoxication by substances, such as carbamates and organophosphates, we performed the acetylcholinesterase test, which determined the plasma levels in red blood cells of enzymes responsible for the hydrolysis of acetylcholine, namely acetylcholinesterase (AChE) and butyrylcholinesterase (BChE).²³ In Brazil, organophosphates are the ones that most cause poisoning.^24,25 Even if these signs and symptoms are not exclusively produced by pesticides, World Health Organization recommends to consider a probable intoxication if three or more of these symptoms appear after pesticide exposure, and, therefore, be properly diagnosed in health services.²⁶ According to the National Report on Health Surveillance of Populations Exposed to Pesticides,²⁷ notification of exogenous intoxication by pesticides is mandatory and must be realized at the moment of suspicion or confirmation. Despite the legislation being clear, the Ministry of Health recognizes that for every reported case of intoxication, another fifty go unnoticed, which gives the problem the status of a, public health problem. The proper diagnosis and treatment of acute poisoning in farmers is still a problem for the health services in Brazil, which points to the need for changes in the training processes and permanent education of these professionals.If the diagnosis and treatment of acute poisoning cases in farmers are considered an obstacle to health services, it increases when dealing with chronic damage. Although studies have shown the relationship between chronic exposure to pesticides and depression, cancer, Parkinson's disease, Alzheimer's, reproductive and endocrine problems, pulmonary fibrosis, hepatotoxicity, and dermatitis, among others,^{2–5,28–30} few services adequately investigate the relationship between these diseases and exposure to pesticides.

Thus, new studies must be carried out in different regions and countries, so that the data set can increase the number of evidence that is capable of proving these relationships.

The data set indicates that farmers are exposed to risks due to the inappropriate use of PPE. It is noticed that a high number of workers presented acute symptoms after the use of pesticides. Therefore, it is necessary to raise awareness among farmers about the risks of human and environmental exposure to these products. Health professional are able to identify, analyze and implement measures that minimize risks to this population, based on their professional practice. This can favor the improvement of the quality of life of farmers.

None.

This research did not receive external funding, but the researchers were awarded research grants for exclusive dedication to the project by the National Council for Scientific and Technological Development (CNPq).

Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Caxias do Sul University, protocol code 17010519.1.0000.5341, August 8th, 2019.

Informed consent statement: Consent was obtained from all subjects involved in the study.

The authors declare no conflict of interest.

1. Londres, F. Pesticides in Brazil: a guide for action in defense of life. Rio de Janeiro: AS-PTA - Assessoria e Serviços A Projetos em Agricultura Alternativa, Brasil; 2011. 191 p.
2. Carneiro AF, Augusto LGS, Rigotto RM, et al. ABRASCO Dossier: an alert about the impacts of pesticides on health. Rio de Janeiro: EPSJV; São Paulo: Expressão Popular, Brasil; 2015. 623 p.
3. Bombardi LM. Geography of pesticide use in Brazil and connections with the European Union. São Paulo: Laboratório de Geografia Agrária, FFLCH, USP; 2017. 296 p. ISBN: 978-85-7506-310-1.
4. Kim K, Kabir E, Jahan SA. Exposure to pesticides and the associated human health effects. Science of the Total Environment. 2017;575:525–535.
5. Ministry of Health. Secretary of Health Surveillance. Department of Environmental Health and Occupational Health. General Coordination of Environmental Health Surveillance. Guiding Document for the Implementation of Health Surveillance of Populations Exposed to Pesticides. 1st edn. Brasília: Ministério da Saúde; 2012.
6. Porto MF, Soares WL. Development model, pesticides and health: an overview of the Brazilian agricultural reality and proposals for an innovative research agenda. Revista Brasileira de Saúde Ocupacional. 2012;37:17–31.
7. Brasil. Resolution-RE No. 2,080, of July 31, 2019. Official Gazette of the Union, Brasília, 01 agosto de 2019.
8. Hupffer HM, Engelmann W, Weyrmüller AR. Future with or without pesticides: global socioeconomic impacts and new technologies. São Leopoldo, Brasil: Casa Leiri,; 2021. 200 p.
9. Gilson IK, Rocha LG, Silva MRV, et al. Pesticides released in the years 2019-2020: a discussion on the use and toxicological classification. Brazilian Journal of Development. 2020;6:49468–49479.
10. Rebouças MA, Lima VLA. Socioeconomic characterization of family farmers who produce and do not produce irrigated papaya in the agrovila canudos, Ceará Mirim (RN). Holos. 2013;2:79–95.
11. Polit DF, Hungler BP. Fundamentals of research in nursing. 3rd edn. Porto Alegre: Artes Médicas; 1995.
12. IBGE. Brazilian institute of geography and statistics. IBGE Cidades. 2019.
13. Santos GEO. Sample calculation: online calculator. 2019.
14. Andreotti G, Koutros S, Hofmann JN, et al. Glyphosate use and cancer incidence in the agricultural health study. Journal of the National Cancer Institute. 2018;110:509–516.
15. Kachuri L, Harris MA, MacLeod JS, et al.Cancer risks in a population study of 70,570 agricultural workers: results from the Canadian Census Health and Environment Cohort (CanCHEC). BMC Cancer. 2017;343.
16. Fioreze CC. The use of personal protective equipment in the management of pesticides in the cultivation of garlic and grapes in the municipality of São Marcos/RS and its relationship with acute poisoning. 2021. 56 f. TCC (Graduação) - Curso de Enfermagem, Universidade de Caxias do Sul, Caxias do Sul, Brasil; 2021.
17. Amr S, Dawson R, Saleh DA, et al. Pesticides, gene polymorphisms, and bladder cancer among Egyptian agricultural workers. Archives of environmental & occupational health. 2015;70:19–26.
18. Brasil. Ministry of labour. Ordinance No. 3,214, June 8, 1978. Approves the Regulatory Norms - NR - of Chapter V, Title II, of the Consolidation of Labor Laws, relating to Occupational Safety and Medicine. Brasília, 08 June 1978.
19. Brasil. Decree No. 4,074, of January 4, 2002. Regulates Law No. 7,802, of July 11, 1989. Federal Official Gazette, Brasília; 2002.
20. Pinto DN. The use of Personal Protective Equipment in the handling of pesticides and the frequency of acute poisoning. 2018. 58 f. TCC (Graduation) - Nursing Course. Universidade de Caxias do Sul, Caxias do Sul; 2018.
21. Brasil. Ministry of Health. Guiding document for the implementation of health surveillance of populations exposed to pesticides. 2013.
22. Santos ACM, Soares IP, Moreira JC, et al. Profile of clinical information in medical records of tobacco farmers in Alagoas, Brazil. Revista Brasileira de Medicina do Trabalho. 2017;15:310–316.
23. Eddleston M. Pesticides. Medicine (United Kingdom). 2016;44(3):193–196.
24. Ramos A, Filho JFS. Exposure to pesticides, labor activity and health problems. Revista Médica de Minas Gerais. 2004;14:41–45.
25. Barbosa RS, Souza JP, Almeida DJ, et al. The possible consequences of exposure to pesticides: a systematic review. Research, Society and Development. 2020;9(11):e45191110219.
26. Faria NMX, Rosa JAR, Facchini LA. Pesticide poisoning among rural fruit workers. Bento Gonçalves/RS. Revista de Saúde Pública 2009;43:335–344.
27. Brasil. Ministry of health. Secretary of health surveillance. National report on health surveillance of populations exposed to pesticides. 2018.
28. Dhananjayan V, Ravichandran B. Occupational health risk of farmers exposed to pesticides in agricultural activities. Environmental Science & Health. 2018;4:31–37.
29. Sabarwal A, Kumar K, Singh RP. Hazardous effects of chemical pesticides on human health–Cancer and other associated disorders. Environmental Toxicology And Pharmacology. 2018;63:103–114.
30. Lopes CVA, Albuquerque GSC. Pesticides and their impacts on human and environmental health: a systematic review. Saúde em Debate 2018;42:518–534.