Estimating underreported pesticide poisonings in Nicaragua

Abstract

We undertook to estimate the degree of underreporting to a regional pesticide poisoning registry, and to estimate the true incidence of poisoning in an agricultural region of Nicaragua. We surveyed 633 workers at 25 of 33 agricultural cooperatives and any nearby private farms in a area geographically convenient to the regional health headquarters with a short structured interview about pesticide poisonings. Eighty‐three percent of workers described current use of pesticides. Twenty‐five percent described a pesticide poisoning in the preceding 12 months, and almost one‐half (48%) described having been made ill by pesticides at some point in time. Sixty‐nine (11%) described a poisoning in the preceding month, 23 of whom had received medical attention. The names of the medically treated were sought in the Regional Pesticide Poisoning Registry for the survey year of 1988. Only 8 of the 23 subjects were found reported to the registry when a total of 1,143 human pesticide poisonings were reported in the entire region. Using 65% as an estimate of underreporting to the registry, we calculate that 3,300 (95% Cl 2100–7500) poisonings had received treatment in the region in 1988, of whom more than 2,100 remained unreported. Based on the ratio of total poisonings (treated and untreated) to registry‐reported poisonings among our survey respondents, we estimate that 6,700 (95% Cl 4100–18000) systemic poisonings, occurred in 1988 in the region. Underreporting of pesticide poisonings disguises the enormity of the problem in developing countries. Even in a region with a strong emphasis on illness reporting for targeted conditions, underreporting is substantial. This method for estimating underreporting is easily applied and provides a rough estimate of registry underreporting and actual incidence for conditions identifiable by a community‐applied questionnaire. © 1996 Wiley‐Liss, Inc.

Trabalho rural e intoxicações por agrotóxicos

“…A partir dos episódios de intoxicações ao longo da vida e dos anos de exposição aos agroquí-micos, construiu-se uma estimativa da taxa bruta de incidência de intoxicações, para cada 100 trabalhadores por ano de exposição química 2,12 …”

“…Talvez por isso, não tenha sido encontrada diferença por sexo na incidência de intoxicações. Em outros estudos, o predomínio de exposição e intoxicações foi masculino 2,3,19 com exceção do estudo na Coréia, que apontou um aumento de 3,9 vezes no risco feminino de intoxicação 23 .…”

“…O uso de agrotóxicos na agricultura é intensivo, multiquímico e várias publicações têm apontado as intoxicações por agrotóxicos como um grave problema de saúde, especialmente entre trabalhadores rurais 1,2,3 . Contudo, são escassos os estudos brasileiros de base populacional sobre as características do uso ocupacional ou sobre as intoxicações por agrotóxicos 4,5 .…”

“…Apesar da importância das intoxicações por agrotóxicos, os índices de sub-registro são enormes. Na Nicarágua, onde é obrigatória a notificação, apenas 35,0% dos casos atendidos em serviços de saúde e 17,0% do total populacional dos casos foram registrados 2 .…”

Commentary

“…This is a research training program sponsored by the Research Department (SAREC) of the Swedish International Development Authority, run since 1987. It has resulted in the completion of three doctoral programs in occupational epidemiology and the publication of several reports (13)(14)(15)(16)(17)(18). The program addresses miners' health, lung function in workers with various exposures, and neurotoxic effects of organophosphate insecticides.…”