Assessment of Primary Health Care for rural workers exposed to pesticides

Abstract

OBJECTIVE: To evaluate the attributes of Primary Health Care (PHC) for rural workers; to analyze sociodemographic conditions, history of poisoning and hospitalizations for pesticides and use of personal protective equipment; and to verify exposure to pesticides by determining bioindicators. METHODS: Cross-sectional, descriptive-analytical study with a sample of 1,027 rural workers living in municipalities belonging to a regional health department in Southern Minas Gerais, whose PHC is governed by the Family Health Strategy model. We used the adult version of the Primary Care Assessment Tool (PCATool Brazil) and a structured questionnaire to collect socioeconomic data, history of poisoning and hospitalization for pesticides and use of personal protective equipment. Blood samples were collected to measure biomarkers of pesticide exposure and signs of renal and hepatic sequelae. RESULTS: Low education was prevalent, as well as the intense contact of workers with pesticides. Frequent use of personal protective equipment was higher among men, as was the history of poisoning and hospitalizations for pesticides. Rates of 20% poisoning, 15% liver disease and 2% nephropathy were detected. Signs of hepatotoxicity were more frequent in men. Gender differences were all statistically significant. Regarding PHC, only the attribute “degree of affiliation” had a high score. None of the poisoning cases detected in the study were previously diagnosed. CONCLUSIONS: Despite the high coverage of the Family Health Strategy, occupational risk and its consequences have not been detected by health services, which do not seem oriented to primary care, even lacking their essential attributes. There is a need for immediate and effective adaptation of public policies regarding the health of rural workers, with adequate training of teams and review of the portfolio of PHC services offered.

Courses on Basic Occupational Safety and Health: A Train-the-Trainer Educational Program for Rural Areas of Latin America

“…The teams realized that the relationship between work and community health problems was unknown to the communities' health care staff. This so-called "blind spot" in occupational health [51,52] of health care providers is well known globally [24,25,41,49,[51][52][53][54]. Likewise, local authorities were unaware of the association between work and health.…”

“…Likewise, local authorities were unaware of the association between work and health. This might indicate that the inclusion of occupational health into PHC as suggested by PAHO still needs to be translated into local policies [21,24].…”

“…For example, for one case of pesticide poisoning notified, 50 are not reported [23]. The absence of infrastructure, adequate public policies, accessibility, and trained primary healthcare professionals in occupational health is a prevailing barrier not only in Brazil [1,19,20,24,25].…”

Características socioeconômicas e perfil de saúde auditiva de trabalhadores rurais do semiárido nordestino

“…Farmers are exposed to several types of agents harmful to health, including the noise and vibration of agricultural machinery, agrochemicals, and excessive solar radiation. These harmful agents are considered, either alone or together, as the causes of diseases correlated with the health of the rural worker (3,4) .…”

“…Isolated or together, the use of agrochemicals in rural activity is another significant risk factor to the farmer, with great repercussions on the integrality of his health. This population of workers is vulnerable to exposure and intoxication by pesticides due to the degree of toxicity and the improper use of these substances, or even by not using protective equipment and unprepared health services (4) .…”