ปัญหาสุขภาพเกษตรกร

1. ปัญหาสุขภาพเกษตรกร

2. ปัญหาสุขภาพเกษตรกร • ๑.การบาดเจ็บทั้งฉับพลันและเรื้อรัง • ๒. โรคระบบการหายใจ • ๓.การได้รับพิษสารเคมีการเกษตร • ๔.โรคมะเร็ง • ๕.โรคผิวหนัง

3. ปัญหาสุขภาพเกษตรกร • ๖.การติดเชื้อ • ๗.การเสื่อมการได้ยิน • ๘.ปัญหาสุขภาพจิตและระบบประสาท • ๙.ความผิดปกติของกล้ามเนื้อและข้อ • ๑๐. ภยันตรายจากสภาพแวดล้อมกายภาพ

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

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

6. Agricultural Chemical Exposures • Fertilizers • Pesticides • Fumigants • Miscellaneous

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

8. 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

9. Report Case of Pesticide Poisoning by Year, Thailand 1977-1998

10. Insecticides4 main chemical groups • Synthetic organic chemicals • Inorganic chemicals • Biologics • Botanicals

11. Insecticides4 main chemical groups • Synthetic organic chemicals • organophosphates • carbamates • organochlorines

12. Insecticides4 main chemical groups • Inorganic chemicals: • metals: arsenic, thallium • cyanide

13. Insecticides4 main chemical groups • Biologics • pheromones • bacteria, viruses • Botanicals • pyrethrins

14. Proportion (%) of Pesticide poisoningby Type of Chemical, Thailand, 1998

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

16. 2 categories of victims exposed to pesticides • Occupational • Nonoccupational

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

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

19. Non-occupational Exposure • Children • esp. < 10 years old • Consumers

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

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

22. SOURCES PATHWAYS RECEPTORS Engineering Education Enforcement Measures to Prevent Farm PoisoningPrimary Prevention

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

24. Measures to Prevent Farm PoisoningPrimary 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.

25. 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

26. Measures to Prevent Farm PoisoningPrimary 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

27. Measures to Prevent Farm PoisoningPrimary 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

28. 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.

29. 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

30. 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.

31. 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.

32. 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.

33. 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.

34. Measures to Prevent Farm PoisoningPrimary Prevention • Closed-system product & equipment designs • Strict adherence to pesticide labels • Proper protective clothing when using toxic chemicals • Child safety emphasis.

35. Measures to Prevent Farm PoisoningSecondary Prevention โรคเป้าหมายนั้นต้อง • เป็นปัญหาใหญ่เพียงพอในกลุ่มประชากร ที่ทำให้ผลการตรวจคัดกรองนั้นเชื่อถือได้ • เป็นที่เข้าใจถึงธรรมชาติการดำเนินของโรคนั้นแล้วเป็นอย่างดี และมีระยะปลอดอาการนาน ก่อนเริ่มแสดงอาการ

36. Measures to Prevent Farm PoisoningSecondary Prevention โรคเป้าหมายนั้นต้อง • มีหลักฐานยืนยันว่า การตรวจพบโรคนั้นตั้งแต่ระยะต้น ทำให้มีผลลัพธ์ต่อสุขภาพดีขึ้นกว่าการตรวจพบเมื่อมีอาการ • มีการรักษาที่ได้รับการพิสูจน์แล้วว่ามีประสิทธิผล • มีวิธีการตรวจคัดกรองที่แม่นยำ

37. Measures to Prevent Farm PoisoningTertiary Prevention • Educated farmers and related person about first aid and lifesaving in emergency situations • Improved 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 medicine

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

39. Important Considerations for Transportation of Poisoned Farm Victims • Identify source of chemical exposure; collect label if available • Optimize transportation • Wear protective clothing

40. สวัสดีครับ