47 APACPH CONFERENCE Bandung, 21-23 October 2015apacph2015.fkm.ui.ac.id/ppt/22 October 2015/6. FP Environmental... · 47th APACPH CONFERENCE Bandung, 21-23 October 2015 *R i Af i

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47th APACPH CONFERENCE 47th APACPH CONFERENCE

Bandung, 21-23 October 2015

*R i Af i Afif h 1 E H i 1 Ed i *Raisa Afni Afifah 1, Ema Hermawati 1, Edwin van der Maden 2, Melliza Wulansari 3 , Abdur Rahman 1

*1 : Faculty of Public Health, Universitas Indonesia

*2 : Centre for Development Innovation (CDI), Wageningen UR

*3 : Fresh Dynamic Indonesia

*

**Various types of pesticides

*Effects due to exposure to pesticides: biochemical h i h ki di d l i l changes in the enzyme, skin disorders, neurological

disorders, and reproductive disorders.

*Brebes Region has high productivity in agricultural Brebes Region has high productivity in agricultural products, and also high users of pesticides

*Does farm workers have neurogical disorders related Does farm workers have neurogical disorders related to their pesticide use experiences?

*

**cross-sectional studi

*121 farm worker (farm employee and harvester) from five villages at Kersana Sub-District, Brebes, Central J I d i Java, Indonesia.

* Interviewed about risk factors (periode of exposure PPE usages nutritional status knowledge exposure, PPE usages, nutritional status, knowledge related to pesticide, age, sex, smoking behaviours) and 23 symptoms related to neurological disorders.

*Symptoms of neurological disorders questionnaire adopted from the Agricultural Health Study

**Data analized using Chi-Square test

*No Name of Variables Details1 Neurological Symptoms and signs of the neurological system disorders, both

disorders in central or preipheral system, which ever occured in respondents within last 12 months before being interviewed.Result :< 10 di d d ≥ 10 di d (K l t l 2005)< 10 disorders and ≥ 10 disorders (Kamel et al, 2005)

2 Years experience The time span since respondents active as a farm workers until the time of interviewthe time of interviewResult : ≤ mean or > mean

3 Working hour per week

Total duration of work in a week. Result : ≤ 30 hours/week or > 30 hours/week (Lubis, 2002).

4 Last time of use The last time of respondents working related to pesticide. Result : 1 ≥ 2 weeks ago or < 2 weeks ago (for neurological disorders; 1. ≥ 2 weeks ago or < 2 weeks ago (for neurological disorders;

Raini, 2007, Kamel et all, 2005)

No Name of Variables

Details

5 A Ti f d t’ bi th til th ti f 5 Age Time span from respondent’s birth until the time of interview. Result : 1 Ad lt 26 45 ld d ld l 46 65 ld 1. Adult : 26-45 years old and elderly: 46-65 years old

(Indonesia Ministry of Health) ≤ Mean and > mean (44 years old)

6 Sex Identity which distinguished physically by the external genital organsResult : Male or female Result : Male or female

7 Nutritional status Expression of nurtiture balance in certain variables (Body Mass Index BMI) Mass Index, BMI) Result : Normal and overweight (>18,5 Kg/m2) or Underweight (≤ 18 5 Kg/m2)(≤ 18,5 Kg/m )(Supariasa, Bakri, and Fajar, 2001)

No Name of Variables Details

8 Smoking behaviour

Smoking behaviour that generally owned by respondentResult : Yes or No

9 PPE usages Personal Protective Equipment (PPE) completeness when working in field, consist of hat, google/eyeglasses, masker, g g g y glong clothes, gloves, apron, and boots. Result : Complete : If the farm workers at least usually use masker, long clothes, gloves, and hat. Uncomplete : If the farm workers not usually use at least one of masker, long clothes, gloves, of hat. (Nurhayati, 1997)

10 Knowledge related Respondent’s ability to define or mention anythings related to pesticide to usage, maintenance, or hazard/health impact of

pesticides. Result : Good : If respondents can answer > 5 questions correctly. Poor : If respondents only answer ≤ 5 questions correctly. (Zuraida, 2012)

*

*The symptoms shown in Tables below

*Neurological disorder symptoms N %

Mount of symptoms in last 12 months

< 10 symptoms 73 60 3< 10 symptoms 73 60,3

≥ 10 symptoms 48 39,7

Total 121 100,0

Symptoms

dizziness 102 84,3

headache 104 86,0

nausea/vomiting 48 39,7

feeling tense/anxious/nervous 49 40 5feeling tense/anxious/nervous 49 40,5

feeling tired sleepy or low energy most of the day 68 56,2

sweating a lot more than usual 43 35,5

difficulty with balance 32 26,4

forgetful, or confused 68 56,2

difficulty concentrating 49 40,5

fast heart rate 78 64,5

difficulty seeing at night 20 16,5

blurred/double vision 40 33,1

lost of appetite 45 37,2

shaking/trembling hands 39 32,2

momentary loss of consciousness 6 5 0momentary loss of consciousness 6 5,0

feeling excessively irritable or angry 25 20,7

feeling depressed/indifferent/withdrawn 10 8,3

difficultry falling asleep/staying asleep 59 48,8

difficulty speaking 9 7,4

weakness in arms or legs 47 38,8

twitches ,jerks, or involuntary movement of arms or legs 53 43,8

Numbness or pins-and-needles in hands/feet 43 35 5Numbness or pins and needles in hands/feet 43 35,5

changes in sense of smell or taste 6 5,0

*Pesticides use (periode) N %

Y iYear experience

≤ 24 years 63 52,1

> 24 years 58 47 9> 24 years 58 47,9

Total 121 100,0

Working in weekg

≤ 30 hours 93 76,9

> 30 hours 28 23,1

Total 121 100,0

Last time use

≤ 2 weeks ago 17 14,2

> 2 weeks ago 104 85,8

Total 121 100,0

Neurological disorder symptoms

Variabels

g y p

OR (CI 95%) P-value< 10 symptons(%)

≥ 10 symptoms(%)

Year experince ≤ 24 years 36 (57,1) 27 (42,9%)0,76 (0,36-1,57) 0,465

> 24 years 37 (63,8) 21 (36,2)

Working in week ≤ 30 hours 62 (66,7) 31 (33,3)3,09 (1,29-7,40) 0,015*

30 h 11 (39 3) 17 (60 7%)> 30 hours 11 (39,3) 17 (60,7%)

Last time use ≤ 2 weeks ago 10 (58,8) 7 (41,2)

0,91 (0,32-2,58) 1,000

> 2 weeks ago 63 (61,2) 40 (38,8)

*

Neurological disorder symptoms

Variabels

g y p

OR (CI 95%)P-

value< 10 symptons(%)

≥ 10 symptoms (%)(%)

Age Adult 39 (54,9) 32 (45,1)0,57 (0,27-1,22) 0,187

Elderly 34 (68,0) 16 (32,0)

Sex Male 16 (66,7) 8 (33,3)1 40 (0 55 3 59) 0 641,40 (0,55-3,59) 0,64

Female 57 (58,8) 40 (41,2)

N l tBMI

Normal to overwight

68 (60,7) 44 (39,3)1,24 (0,32-4,86) 0,739

Underwight 5 (55,6) 4 (44,4)

Neurological disordersymptoms

Variabelssymptoms

OR (CI 95%) P-value< 10 symptons

(%)≥ 10 symptoms

(%)

K l d l t dKnowledge related pesticide

Good 28 (66,7) 14 (33,3)1,51 (0,69-3,3) 0,334

Poor 45 (57,0) 34 (43,0)

PPE use Complete 28 (59,6) 19 (40,4)

0,95 (0,45-2,00) 1,000I l 45 (60 8) 29 (39 2)Incomplete 45 (60,8) 29 (39,2)

Smoking No 62 (58,5) 44 (41,5)0 51 (0 15 1 72) 0 3990,51 (0,15-1,72) 0,399

Yes 11 (73,3) 4 (26,7)

*

** Acetylcholine (Ach) synthesized

* Released by nerve fibers

* Binding to receptor

** Passing the message

* Bring about response

* Ach highAch high

* Cholinesterase enzym release to hydrolize Ach back to normal

*

* Cholinesterase inhibitors * causing increased bind to cholinesterase resulting in increased acetylcholine in the

parasympathetic activity i.e. vasodilatation, constriction of pupils in the eyes, increased secretion of sweat saliva and synapses secretion of sweat, saliva and tears, slow heart rate, mucus secretion in the respiratory tract and constriction of bronchioles and so on.

Expose to farm worker

Neurological disorderOrganophosphat and

carbamate are pesticide k > 30

hours/weekknown asCholinesterase inhibitor + OC + pyrethroids+ h b dherbicide

*C n l i n *Conclusions: *Symptoms of neurological disorders appeared

possibly related to pesticide exposure.*especially time per week, which is more than 30

hours per week. *RecomendationRecomendation* It is recommended to contact with pesticide not

more than 30 hours per week. *To minimaze pesticide exposure, farm workers have

to wear full personal protective equipment.

**