KNOWLEDGE, ATTITUDE, AND PRACTICE (KAP) OF USING

KNOWLEDGE, ATTITUDE, AND PRACTICE KAP OF USING PERSONAL PROTECTIVE EQUIPMENT PPE FOR CHILLI- GROWING FARMERS IN HUARUA SUB-DISTFUCT, MUEANG DISTRICT, UBONRACHATHANI PROVINCE, THAILAND S

KNOWLEDGE, ATTITUDE, AND PRACTICE (KAP) OF USING PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR CHILLI- GROWING FARMERS IN HUARUA SUB-DISTFUCT, MUEANG DISTRICT, UBONRACHATHANI PROVINCE, THAILAND

Saowanee Norkaewl, Wattasit Siriwongl, 2, Sumana Siripattanakul3, and Mark Robson2~4~ 5

1 College of mtblic Health Sciences, Chulalongkorn University, Bangkok, Thailand

2 Thai Fogarty ITREOH Center, Chulalongkorn University, Bangkok, Thailand

3 Faculty of Engineering and National Center of Excellence for Environmental and Hazardous Waste

Management, Ubon Ratchathani University, Ubonratchathani, Thailand

4 School of Environmental and Biological Sciences, Rutgers University, New Brunswick, N J , USA

5 UMDNJ-School of Public Health, Piscataway, NJ, USA

ABSTRACT: Pesticide use in Thailand has increased significant, raising concerns

about potentially adverse effects on human health and environment, in particular,

a s a number of pesticide products have been heavily used on chilli farms The

objectives of this study were: (1) to assess the knowledge, attitudes, and practices

on using personal protective equipment (PPE) of chilli-growing farmers to protect

themselves from pesticides, (2) to evaluate the knowledge, attitudes, and practices

associated with pesticide use and exposure in the chilli-growing farmers, and (3)

to provide recommendations and guidelines to reduce the exposure to pesticides

among farmers in Huarua Sub-District, Mueang District, Ubonrachathani

Province, Thailand A standardized questionnaire was completed through face to

face interviews with 330 chill-growing farmers The results showed that 53% of

the participants were male and 39.6% and ages ranging between 31-40 years

71.2 % had received primary school education and most of them applied

pesticides by themselves Almost 89.4% of respondents acknowledged that they

ought to wear mask, boots, and cloth while spraying Furthermore, 83.3% knew

that pesticides can pass through their body in 3 ways; ingestion, dermal contact,

and inhalation In addition, 45.5% of respondents knew that spraying should be

done in the windward direction and that they should use PPE Many of the

respondents checked their equipment before using them and wore clothing while

spraymg Nevertheless, 77.2 % of chilli-growing farmers had low level of

knowledge, 54.5 % of the farmers were not concerned about pesticide use or

exposure, and 85.0 % of farmers demonstrated a fair level of actual usage The

associations between knowledge and attitude, knowledge and practice, and

attitude and practice demonstrated statistical significance with low positive

correlation (0.2 16, 0.285, and 0.305 respectively,) The results suggested that

government authorities and communities should be provided with the appropriate

recommendations, strategies and guidelines to prevent adverse health effects

regarding to pesticide exposure of farmers in this area

Keywords: Knowledge, Attitude and Practice (KAP), Pesticide, Personal Protective

Equipment (PPE), Thailand

INTRODUCTION: Pesticides are widely used 80,000 tons in 2004 The majority of imported throughout the world, especially in agriculture pesticides in recent years were herbicides, for crop protection, especially within a n insecticides, fungicides, a n d plant growth agricultural country s u c h as Thailand, regulators In Asia, Thailand ranked fourth in Approxjmately 40% of the country's area is annual pesticide consumption The average agriculture and comprises 60% of the total pesticide use is very high and Thailand is the national workforce') In order to encourage country with the thrd k g h e s t pesticide use rate, agncultural production, farmers used large following Korea and Malaysia21 Even though amounts of agrochemicals including fertilizers pesticides increases crop it h a s effects on and pesticides T h d a n d h a s increased the human health An important problem related to amount of pesticides imported with agriculture is pesticide poisoning In 2008, approximately 21,000 tons in 1994 to over highest number of illnesses was from pesticide

* To whom correspondence should be addressed

E-mail: wattasit.@chual.ac.th Tel 662-2188231

J Health Res 20 70, 24(~"pppi 2): 93- 100

poisoning and account for 79.63 % of total

occupational diseases31 Health Systems

Research Institute (2005) reported that Thai

farmers are at risk due to pesticide poisoning

because of inappropriate pesticide use, incorrect

use of PPE and a lack of understanding

regarding pesticide toxicity4) Normal misuse of

pesticides usage included amounts or

concentrations exceeding that recommended,

mixing various pesticides together, inappropriate

use of PPE while mixing or applying pesticides,

improper disposal of pesticides, and a lack of

awareness and knowledge

Ubonrachathani Province is located in the

northeast region of Thailand with average

temperatures in the dry season (October to

Apnl) of 24.69'C Of a total area of 16,112 km2,

10,577.66 km2 is used for crop cultivation and

vegetations) Ubonrachathani produced various

agricultural products such a s rice, cassava,

c m , and rubber trees with a hgh usage of crop

protection and cultivation agents6)

The objectives of this study was to assess

the knowledge, attitude and practice on using

personal protective equipment, to evaluate the

knowledge, attitudes, and practices (KAP)

associated with pesticide use and exposure in

cm-growing farmers, and to provide

recommendations and guidelines to reduce

pesticide exposure among chilli-growing farmers

in Huarua Sub-District, Mueang District,

Ubonrachathani Province, Thailand

cross sectional study knowledge, attitude, and

practice (KAP) of using personal protective

equipment (PPE) among ch&-growing farmers

in Huarua Sub-District, Mueang District,

Ubonrachathani Province The study population

was concentrated on farmers who use pesticides

to control pest in chilli farms and included 330

farmers that apply pesticides on their farms The

majority were farm owners that have controlled

and mixed volume of pesticide and sprayed

pesticide by themselves This study calculated

sample size from population sizeq The farmers

were selected by convenient sampling in this

area; were more than 18 years of age, included

men and women who were not pregnant

The measurement tool used was by

rno-g a standardized questionnaire that had

been previously used among tangerine farmers

in a pesticide safe use project89 9, ' 0 ) It sought to

assess the knowledge, attitude and practice on

using personal protective equipment of chilli-

growing farmers The questionnaire consisted of

the following five parts: (1) socio-demographic

characteristics, (2) information regarding

pesticide use, (3) knowledge regarding use of PPE to limit pesticide exposure, (4) attitude towards pesticide usage and PPE, (5) practice on using pesticide and PPE

RESULTS: The ages of participants ranged from

24 to 70 years old, with an average age of 42 years The majority of the participants were male (53.00%), couple (87.9 %), and head of family (51.5%) In this study, 71.2% of respondents graduated from primary school and 57.6% of the respondents had an income less than 50,000 baht Approximately 84.8% of the respondents were farm owner and 75.8 % of respondents owned less than 3 rais or 1.19 acres of land Table 1 demonstrates the general profile sample population

Table 1: Socio-demographic characteristics

Age (years)

Mean 2 SD = 42.0 + 10.7 Range= 24 to 70

Gender

Marital status

Status in family

Education

Income (Baht/ year)

land owner (1 rai = 1,600 sqm2)

Property relationship

J Health Res 20 10, 24(11tppI 2): 93-100

When examining problems that respondents

encountered during growing crops, 84.8% listed

insects as the main problem, flowed by weed

(60.6%) and plant disease (74.2%) Furthermore,

47% of participants claimed that they applied

abamectin, 23.3% applied selecron (profenofos),

and 14.9% used podium600 (chlorpynfos)

14.9% to their crop Typical pesticide

applications included self-spraying (8 1 Bolo)

Although 77.3% of the respondents claimed that

they did not have any chronic diseases, when

assessing symptoms associated with pesticide

use, results revealed that 57,6% never showed

any symptoms while 39.4% showered few

symptoms of headache, fatigue, dizziness,

stomach cramps, and throat irritation In

addition, 48.5% of respondents claimed that in

the past 12 months, they had taken a

cholinesterase test with normal results while

34.8% had never checked

Furthermore, when farmers felt dl from

pesticide use the same amount of participants

went to health centers a s relied on themselves

(23.3%) On the other hand, 20% of respondents

went to district hospital and alternative

medicine Participants typically obtained

information regarding pesticide use from

agricultural officer ( 17.89%) or television

(1 5.75%) Table 2 demonstrates mformation

regarding problems of weeds, insects, and

pesticide use

Table 2: Information regarding problems of weeds,

insects, pesticide use of participants

Insect problem

Weed problem

Plant disease problem

Animal problem

Common pesticide used

Pesticide Application*

Apply by hired applicator 60 18.2

Congenital disease

Toxicity symptom

How to treat Toxicity symptom associated w i t h

pesticide*

Herbal use by themselves 62 18.79

Snxce of pesticide inf~~nation*

Have you had a cholinesterase test in the last 12 months?

*multiple choices

The average knowledge score among respondents was 6.48 (SD=2.64) whereas scores ranged between 2 to 11 with 70% of respondents receiving scores ranging between 2

to 9 The item with the highest amount of correct responses was to the question, 'When you were spraying pesticide, what is the proper practice?" in which 89.4% respondents recognized that they should use mask, wear boots, and wear proper attire that covers their body entirely Many respondents (83.3%) knew that the pesticides can pass through their body

J Health Res 20 10,24(Sz,~pI2): 93- I00

accumulated in soil, water, air and vegetables &dice the jirst aid 190 57.6 that were sprayed Furthermore, they were in case of acute

via 3 routes; ingestion, dermal contact and

inhalation About 71% of respondents knew that

the pesticides were contaminated and

Correct

13.Whatisthesymptomoflongte1m 200 60.6

d c i d e m ?

More than half of them (57.6%) followed the

pesticides, cleaned equipment with detergent,

showered and immediately changed their

clothes after pesticide spraying In addition, 47%

of respondents were concerned about the

manufacturer and expiration dates, selecting

pesticides based on the desired type of pest

erahcation Approximately, 26% of them knew

that pesticides were hannful to all living things

and were aware that drinking pesticides by

- -

aware that long term pesticides exposure

symptoms causes dizziness and feel dry (60.6%)

I

*negative statement

The results demonstrated that 77.2% of respondents had a low level of knowledge, 22.8% of them had a moderate level, while none of the farmers demonstrated a high level of knowledge of using PPE The results can be found in Table 4

Table 4: Distribution of knowledge levels of using PPE

mcide?

+ , i,,,ofdrinkdcide?

Knowled e level

Low level (160%) Moderate level (60%-80%)

Hi level 81%- 100°h accident could cause vomiting About 20% of to table

5, appmximately 38% of them knew about the toxicity and harmfulness

respondents considered pesticides harmful to

of pesticides based on the colors used on

pesticide labels, keeping pesticides separately in human health and the environment They believed

a locked cabinet L~~~ than 20% mixed that exercise could help excrete toxic pesticide pesticides in container before filling spraying through sweat while 34.8% were unsure of whether machines In addition, they disposed of empty dnnlang water after exposure could help in the same pesticide containers by throwing them away in way m e r m o r e , 26% of respondents stated that local waste bins Table 3 demonstrates the

using wmd ~ c k to pesticides Mg was safer number of percentages of participants responses

than using their hands and 45.5% of respondents regarding knowledge o pesticide usage

Table 3: Number and percentage of knowledge believed that spraying should be done in the

canpassthroughthebody?What? I respondents believed that they if used more than the

Correct

1 How many routes that the mcides 275 83.3 -

2: What is dkadmntage of pestkde use? :: zB 1 recommended amount of pesticide whde spraying

3 How to use the pesbcide properly?

4 When you want to buy W d d e , 155 47 that it would increase their crop yield Approximately

windward direction In addition, 40.9% knew that they should use PPE during spraying and 36.4% of

5 How to known toxicity of Wcide? 70 21.2 1

6 What is the axrect method of 1 9 ~ 57.6 the body only ingestion 30.3% of them agree that

7 How to proper mix of pesticides? 60 18.2

8 i i r ~ i m g W h m i s t h e p e s t 1 d d e 235 71.2 1 A

the respondents were considered with after spraying

9 When you we^ spraying pesbdde, shower as a preventive alternative Less

than 30% of

What is the pqxrly practice?

10 What are the pmperly practices the respondents believed that showering was a good afkr @dde used?

11 How to storage the peshcide

product?

preventative alternative after spraying pesticides

75 22.7 1 without wearing PPE Less than 60% of them usually

J Health Res 2010, 2J(supp/ 2): 93- I00

12 How to di- of empty Mcide 50 15.2

Table 5: Percentages of attitudes towards using PPE of each

SLronghl Agree N e u t d Di=P= Strongty

Attitudeitems a p e

1 M d d e can pass through the body only lngeston 9.1 22.7 16.7 33.3 18.2

route *

2 RsticideMtoinsectonly,nothannfulto

human health*

3 Incxax amount of w d d e anyhme of u x to

p r e v e n t h c e *

4 Mix various e c i d e s will i n c m x effectiveness

and no d i m - *

5 Using w o o d - M to mix the pesticides is safety

than using hand

6 Use pesbcides more than label mommendation

may i n c m x yield*

7 Ifyou stand windwad directon when spraying

pesticide, donL concern about clothes*

8 Mcides are hamf~~I to the human health and

environment

9 Drink coconut juice after e x p a d m c i d e for

exaetmg m d d e toxicity*

10 Drink water after e x p & &ride f a exaebng

pesbcide toxicity'

1 1 Exerrise can help to excreting pesbcide tcwcity

throughsweat

12 While you arc spraying peshcide, you should not

wear Cl0thE-g thoroughly *

13 Pesticide can residues in a@- prcck~ct and

its harm to c a x m m e r

14 ~sivechemicalsare~ectivetocontrolpest

bettesthancheapchemicals*

15 If spraying chemical without wearing p r o t h e

equipment, must shower immediately after the spray

as a ureventive alternative*

*negative statement

Table 6 demonstrates attitudes towards PPE

use.54.5% of respondents were not concerned

about using PPE, while 45.5% had a neutral

attitude towards PPE use

Table 6: Distnbution of attitude levels towards PPE

Attitude level

Concern Attitude (8 1%-100%)

Neutral Attitude (60%-80%)

Not concern Attitude

Less than 60% 54.5

Table 7 Illusbates the respondents took showers

immedBtely after spraying 75.8% and 74.2% of the

washed their hand and face with soap after using

pshcides prior to eating Appmumately 68% of

respondents checked e q ~ ~ p m e n t pnor to use and

63.6O/0 wore clothes that c o d their entire body Also

62.1% d d not allow other people or other ammals to be

in the vicinity while spraying Wcides Less than W !

of respondents removed their clotlvng or shoes

immediately afler spraying

More than half of respondents usually read the instructions on use prior to use and followed the

m m e n d a t i o n s , wore gloves and a mask when mixing pesticides, and burned or buried the empty pesticide oontainers aflerwards Less than half of respondents took the time to learn about appropnak type of e c i d e to use, washed the clothes they wore during wearing spraylng irnrndtely & d s , and stocd in the windward direcbon while spraying yet without wearing PPE Apprmbately 30% of respondents used detergents to clean their p h c i d e containers and 59.1% of respondents h e d to have never mated m c i d e s using their bare hands In addtion, 53% of respondents had never smoked or

drank water whde spraying pesticides Half of the

respondents d ~ d not spray pest~cides when the weather was windy Less than 550% of respondents threw empty pesticide containers into a river or resen& Appnximately Wh of respondents d many types

of pesticides together in order to increase effdheness

J Health Res 20 10, 24(supp~ 2): 93- I00

Table 7: Percentages of practice towards using PPE Table 8: Distribution of practices towards using PPE

of pesticide

2.Select pesticide by

n@tor's xrmmmendd/

alhrhmg/price*

3.Read label before use

and fob m e n d a h

4.Check equipment and

material before using

5Avodd human and

animalhmsprayingam

6.WeargloJesandmask

whenmxingpesticides

7.Inhale pesticide for

confirmingpestidde*

8 a pesticide by hand*

9 a various pesticide for

maease decfive radiation *

Good practice (8 1%- 100%)

Poor ractice Less than 60% 3 0

Knowledge, attitude and practice q a d m g use of PPE were anaIyzed using Spearman's rank correlation

d c i e n t s The assmiation between howledge and attitude, knowledge and pracbce, and attitude and

practice demonstrated a low posltive correlation (0.2 16, 0.285, and 0.305 mqxdnely)

W e 9: Asmiation among knowledge, attitude, and mctice ofusing PPE L,

Variables Spearman's rho Coefficient

Knowledge & Attitude 0.2 16*

howledge & Practice 0.285"

Attitude & Practice 0.305*

* Correlation was at 0.0 1 level of significance

tho mu^

12.Smo~ordnnkmg* 4.8 9.1 33.3 53.0

1 3 w ~ pesticide while 1.5 19.7 28.8 50.0

k W

14,Standwindwddirecdon 18.2 19.7 36.4 25.8

while spmyh.1g with out

probxtiw equipment*

used*

16.Dhsp3se pestic.de 1.5 27.3 242 47

coniainen m the w after

used*

17.Cleaning pesticide 25.8 30.3 18.2 25.8

applicators WithdeteIgent

before storage

18.RaM-xle&thswhich 59.1 27.3 10.6 3.0

when

spraying irnmdateb

19.Washing&thswhile 47.0 28.8 13.6 10.6

we;uing spray immdteiy

2O.Storage pzitlcides in 27.3 22.7 21.2 28.8

cabinets

2 1 Ernpy pesticide 51.5 33.3 4.5 10.6

containers should be

burned or buried

22.Wash handandwash 74.2 22.7 1.5 1.5

he with soup befm

having meal

23 Shmimm&teiy 75.8 21.2 1.5 1.5

aflersprzlly

*negative statement

Table 8 showed the distributions of practioes of

-dents in uslng PPE While 20% demonstrated

god practice, 85% showed f;3ir practice, and finally 6%

had p r practice

Discusion: In this study, the results showed that

53% of the p a r h c i p t s were male with the average

age of 42 years More than 70% of respondents were

h m 31 to 50 years and most of them were head of

hndy and f m owner These findings are sirmlar to other research that demonstrated that the average age was 43.6 years and 58.4% of the parhcipants were between the ages of 31 to 50 years old and were farm

owners Other research also revealed that the age range of people w o r m in cottage industries was between 25 to 40 years77 11) In general, there is a qqlicant difference of F c i d e use between male and fernalel1) In this study, 71.2 % of respondents

d e d primary school education, which was in amrdance with a study conducted in Braal where 83.2% of workers had less than 8 years of education?

Aim, in another research study underkiken in Nepal data revealed that most of farmers had less than 8 years of education@ The popular pesticides used were

a b a m d , profenofos and chlorpydios The main problem that farmers encountered was insects

(84.8%) Other studies in Thailand found most

h e r s used m c i d e s and the most common used were herbicides and insecticides (ch1opynfos)q

Another study reported that about 92% of the inMewees had worked directly with pesticides?

Similarly, 8 1.9% of f&mers were mixing and s p y i n g pesticides by themselves A study in Lebanon found that a g r i c u l t u d workers received information

x g x c h g F c i d e s through oml communication and had poor protective measureslq

J Health Res 20 10,24 (suppl2): 93- 100

In this study, the majority of dormation about

pesticides was obtained through i n f d sources

such as agncultural officer (17.89%) and television

(15.75O), whch is in a m d a n c e with a similar study

in the field of cottage industries1? T h ~ s study found

that 89.4% wore masks, protective clothmg and

boots, which is slrmlar to another study in Ethiopia

that showed that PPE was commonly used on

farmsl9 On the other hand, a study in Nepal reported

that more than half of the fanners d ~ d not have

knowledge regardug PPE1ll Also, 83.3% mgmzed

that the pesticide could be absorbed in three different

ways and was typically through occupational

exposure@ Most of respondents were aware that

W c i d e s could be accumulated through soil, water,

air and plants, whlch was relatively amsistent with a

study h m Gaza Strip@ In addition, more than half of

respondents followed directions of pesticide labels,

showered and changed imrnedmtely after spraying

pesticides, whch was in accordance with research

undertaken in B d that found that most farmers

showered after working with W c i d e s and followed

label instructions as we117; however in Nepal, half of

respondents did not shower after spraying and a third

wore the same clothes more than once while

spra$ngl1) Approximately one- quarter of respondents

knew the pesticides were harmful to all h gthmgs,

which is dissirmlar to other studies7 11, Q Only few

respondents knew that the type of pesticide they

should use depends on the type of pest they are

atternptung to combat In Nepal, nearly 800/0 of

respondents decided themselves on which pesticides

to use and more than 70% had low level of

knowledgell] This was relative with another study in

Brad whlch found that growers used highly toxic

insecticides7 In addition, respondents considered

pesbcides to be harmful to their health and to the

environment, whch was consistent with other studies7,

11,12)

Attitude regadng spraying pesticides was similar

to a study in Brad wherein farmers were observed

and sprayed pesticides in the same direction as the

wind73 111 Also, a study undertaken in the Gaza strip

reported the symptoms associated with toxic pesticide

exposure among farmers were related to concentration

of m c i d e s usedo Most of respondents mmgmed

that pesticides could pass through the body in other

ways other than ingestion, such as through dermal

contact and mhalationl3 For attitude towards wearing

p r o t e e clothu~g farmers were not aware that h s was necessary, whch agreed with a study in Ethiopia that reported that respondents were careful wMe working with pesticides, which they believed to be

more important than using PPEl9 The respondents chmed that showering would remove pesticides b m contammated body surfaces and most of them did showering after w o r h g with pesticides7, 19

Respondents d ~ d not demonstrate much concern regardug pesticide use and exposure This similar to other studies done in Gaza Stnp that reported that farm workers had misconceived notions rgardmg pesticide use and it was h ~ t h e d that this was the cause of decreased PPE use*, 1% Another study in Thailand reported that less than half of farmers used PPE whde spraying psbcides, washed their hands, showered, or laundered their clothes after ~praymg9~111

In southern Brad, it was reported that over 50% of the agticulkmd workers used protective equipmentl6) More than half of respondents d ~ d not smoker drink

water while spraying pesticidesl1 '3 In terms of the practice of appropriate methods while spraying pesticides, 85% demonstrated a fair level of proper practice Some studies in developing countries were similar, especially with qp-ds to protective

q p m e n t 7 Q The hgh cost of PPE was mentioned as

an important factor in the limited use12, 1S.The association between knowledge and attitude, knowledge and practice, and attitude and practice demonstrated little positive correlation

Conclusions and recommendations: The results

revealed that respondents received primary school education; most of them owning the properties where they worked and used pesticide dmxtly Common

pesticides used during growing season were

a h & , pfmofos and chlorpynfos Typically, respondents received health care services h m a health center and obtained information regardmg pesticide use from agricultural officer A majority of them knew to use PPE and the routes that psbcide

can be absorbed into the body Most of the respondents demonstrated a low level of knowledp regardug PPE and pesticide use, were mostly not concerned about it, and demonstrated a Ewr level of practice in terms of using PPE

Therefore, evidence- based methods should be developed that can assess the occupational health risk

J Health Res 20 10, 24 (~rippI 2): 93- 100

assodated with pesticide use The intervention tools

should be developed for enhancing suitable practice

for PPE usage and to improve the accuracy in the

information given Farmers should be trajned in the

proper usage of personal protective devices Based on

these lindmgs, appropriate policy should be created in

order to increase the knowledge regding the harrml

effects of e c i d e s and the importance of using PPE

at work Therefore educational programs should be

orgamed to increase awareness by h o l m bahhgs

as well as dstributmg literature regardmg PPE and the

hazards of pesticide usage among farmers

Fogarty Center (Grant Number 1 D43 TWO07849

Fogarty International Center - National Institutes of

Health) for fhll rexarch support And we are

appreciated with Dr Srilert Chotpantarat for field

support

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