title: Pesticide use, erythrocyte acetylcholinesterase level and self-reported acute intoxication symptoms among vegetable farmers in Nepal: a cross-sectional study.
abstract: BACKGROUND
  As pesticide use is increasing and proper handling training is lacking, exposure to pesticides and intoxications are an important public health problems among farmers in developing countries. This study describes pesticide use among farmers and compares symptoms of possible acute intoxication and Erythrocyte Acetylcholinesterase(AChE) levels among vegetable farmers with a control group of blood donors in Nepal.
  
  
  METHODS
  A cross-sectional study was carried out among 90 pesticide-exposed farmers and a control group of 90 blood donors. Participants were randomly selected and data were gathered through questionnaires, observation and blood test. Chi-square test, logistic regression and Student's t-test were used for data analysis to describe pesticide use and compare symptoms and AChE levels between the two groups. This study was approved by Nepal Health Research Council.
  
  
  RESULTS
  The majority of pesticides used were WHO class II, classified as moderately hazardous. The mean numbers of personal protective equipment used by farmers were 2.22 (95% CI: 1.89; 2.54). Out of five hygienic practices asked, farmers followed 3.63 (95% CI: 3.40; 3.86) hygienic practices on the average. Farmers reported more symptoms of possible pesticide intoxication in the past month than did controls, mean 5.47 (95% CI: 4.70; 6.25) versus 2.02 (95% CI: 1.63; 2.40) (p < 0.05). The mean haemoglobin-adjusted AChE(Q) was significantly lower among farmers compared to controls, 28.92 (95% CI: 28.28; 29.56) U/g versus 30.05 (95% CI: 29.51; 30.60) U/g, (p = 0.01). The risk of a farmer having lower Q level was about 3 times (OR = 2.95; 95% CI: 1.16; 7.51) greater than controls.
  
  
  CONCLUSIONS
  Nepalese farmers exposed to pesticides have significantly more symptoms of possible pesticide intoxication than a control group of healthy individuals. A lower mean haemoglobin- adjusted AChE level was seen among farmers compared to the controls. The use of highly toxic pesticides, inadequate use of personal protective equipment and poor hygienic practices might explain the reason for symptoms of pesticide intoxication and a lower AChE level among farmers. Education and information of farmers should be undertaken to remediate these problems.
authors.affiliation: Unit of Health Promotion, University of Southern Denmark, Esbjerg, Denmark. neupane.dinesh@gmail.com.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Neupane
authors.forename: Erik
authors.initials: E
authors.lastname: Jørs
authors.forename: Lars
authors.initials: L
authors.lastname: Brandt
mesh_terms: D000110:Acetylcholinesterase / Q000097:blood*; D000328:Adult; D000383:Agriculture; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D009390:Nepal / Q000453:epidemiology; D016273:Occupational Exposure; D010575:Pesticides; D011482:Protective Devices; D057566:Self Report; D014675:Vegetables
chemical_list: D010575:Pesticides; D000110:Acetylcholinesterase