Evaluate the impact of pesticide use to farmer’s health in tea cultivating in thai nguyen and the intervention’s effects

- Suitable model with Policy guidelines of Party and State towards agriculture, farmer and rural, farmer’s health is interested in by whole society. Local Communist Party and Government supported intervention model. Commune government committed to maintaining and to promoting the effect of model “"Farmers - Small business - Medical staff” in which the core of activities is Commune Medical Staff, and pesticide sellers especially the response of farmers. - Intervention model linked the relationship among Farmer - Small business and Medical Staff. Through training courses and conference, trader of pesticides and local medical staff know the communication skills of health education, and know how to use PPE and means of preventing poison of pesticides. Afterbeing trained, the farmer can grasp basic knowledge of preventing pesticide poisoning and especially their trust in trader of pesticides and local medical staff. They are willing to exchange their difficulties when using pesticides to pesticides sellers and local medical staff. - This intervention model “simply but effective” iseasy to deploy in a large scale, the resource don’t need to be fit too much with economic condition in mountainous and highland area. The model has overcome some limitations that some previous encounter model is required enormous resources, the apparatus complex operations, while pouring money into the best result, project completion no pouring money the model is not sustainable, does not exist.

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MINISTRY OF EDUCATION AND TRAINING THAI NGUYEN UNIVERSITY --------------***--------------- NGUYEN TUAN KHANH Evaluate the impact of pesticide use to farmer’s health in tea cultivating in ThaI Nguyen and the intervention’s effects Speccialty: Social hygiene and Health Organization Code: 62 72 73 15 SUMMARY OF PhD THESIS THAI NGUYEN – 2010 The research was conducted at: THAI NGUYEN UNIVERSITY OF MEDICINE AND PHARMACY Advisors: 1. Prof. PhD. Do Van Ham 2. Prof. PhD. Nguyen Van Dip Opponent 1: ………………………………………… Opponent 2: ………………………………………… Opponent 3: …………………………………………. The dissertation will protected in front of State Dissertation Appraisal Council at: Thai Nguyen University of Medical and Pharmacy At…..hours on….. date…………………..month……..year…. The information from this dissertation is available at: - National Library. - Learning Resource Center, Thai Nguyen University. - Library of Thai Nguyen University of Medical and Pharmacy. 1 INTRODUCTION Using pesticides is a objective reality and a indispensable action in agricultural production. World due to the effects of pesticides (P) is estimated about 39 million people yearly acute poisoning and 3 million people among them with heavy acute poisoning and 220 thousand people yearly dead people all over the world. Current situation of poisoning pesticides in Vietnam are still becomes serious. According to Ha Minh Trung, Vietnam is estimated that if there are about 11.5 million agricultural households with rate of 18.26 % poisoned chronic by pesticides, the number of chronic poisoning in the country up to 2.1 million. The main reason is due to abusing and use and indiscriminate pesticides, particularly 98.0 % due to abuse or mix 2 to 3 times condenser than guide on the package, with 84.17 % to 93.23 % not adequate using personal protective equipment (PPE) when spraying. The most pesticides using is in cultivating tea about both quantity and frequency of injection. Thai Nguyen has an area of nearly 16,000 hectares of tea, tea cultivation in many areas of remote and disadvantaged areas, socio-economic conditions of underdeveloped, low education level. Knowledge, practice about using pesticides is still restrictive, which causes bad effect on human health. To contribute for taking care of farmer health cultivating tea and build suitable interfere model with actual condition at these areas, we carry out researching this thesis with a view to: 1. Describe the knowledge, attitude and practice (KAP) of farmer exposure to pesticides. 2. Determine disease model and describe some factors related to farmer health in cultivating tea 3. Construction and appreciate of effect of interfere model on human health protection suitably for current conditions in Thai Nguyen. 2 Charter 1 DOCUMENT OVERVIEW Pesticides is used spreadingly at every nation in the world with income over USD 30 billion from 2005. 1.1. The situation of using pesticides and knowledge, attitude and practice of farmers usually contact with pesticides 1.1.1.The situation of using pesticides Pesticides had existed from ancient period and until19th century, it was used widely but chemical methods at this time have not had big role in agricultural production. From the beginning of 20th century to 1960, oganic pesticides was invented and chemicals is used at maximum level and its bad consequences had started causing human and environment. The period from 1960 to 1980 had left many bad consequences on environment and community health. From 1980s to now, environment protection is paid more attention. In Vietnam, pesticides is used from 1957, means the periods of centered – plan economy from 1957 to 1990: importing and distributing pesticides depends on the state. Amount of pesticides was not used much, only about 15,000 tons per year. Most of them were medicals with so long reserved time or high poison. Period from 1990 to now, market economy with available goods and many types is used in timely. Amount of pesticides is used for heavy industry increasingly. 1.1.2. Knowledge, attitude, practice of person contacting with pesticides. Researches show using situation, unsafe pesticides reservation, lack of knowledge in obeying labor protection methods. Most farmers is lack of awareness, knowledge, subjective attitude about poison and practice untruthfully. 1.2. Effect of pesticides and some of risk factors related to farmer’s health Risk of environment polution: Result for study pesticides at some locals shows that amount pesticides in land, water and food at dangerous level and increasing risk. 3 Effect of pesticides on human health includes pernicious and chronic poison 1.3. Some studied intervention models to protect human health when exposure to pesticides has been deployed out in Vietnam The thesis related to this problem is still rare, especially in mountainous areas, highland such as Thai Nguyen. Some interfere researches have been carried out at some area in Vietnam: The thesis 11-08 of Ministry of Agriculture and Rural Development in combination with Ministry of Health and Ministry of Defence has implemented from 1996 to 2000. In 2002, Bui Thanh Tam and her parner researched community model for using pesticides safety at a district of low land and a district of Northern highland. The subject Job Department of Occupational Health - University Thai Nguyen of Medical and Pharmacy has carried out many thesises related to human health in agriculture labor but it is only at experimental level. Until now, no thesis helps to protect farmer health cultivating tea when contacting with pesticides. Therefore, carrying out a research to take care of farmers here is very nescessary. Charter 2 SUBJECTS AND METHOD 2.1. Subjects 2.1.1. Subjects described - KAP study subjects, examinations assess the actual structure of common diseases and interventions are in direct spray pesticides in the tea growing households, have time for 5 years and tea area about over 1800 m2. - Person investigated and interviewing detail is bosses of pesticides selling shops at Tan Linh commune, People Commitee leader, Chairman of commune farmer Union, Chairman of the Commune Women's Union and some farmers. - Audience research is the only toxic products. 4 2.2. Place of the research Be carried out at Phuc Xuan commune - Thai Nguyen city and two communes including Phuc Linh & Tan Linh, Dai Tu district, Thai Nguyen province. This research is intervention at Tan Linh and controls Phuc Linh commune. 2.3. Time of the research: From January 2007 to June 2010. 2.4. Research method: Epidemiology research design describes cross-sectional design in combination qualitative and quantitative. Participation of community. 2.5. Sample size and sampling method 2.2.1. Sample size for descriptive study Describing sample interviews farmer’s knowledge, attitude, practice (KAP). Applying formula calculating sample size basing rate: n = z2(1- α/2) p(1-p)/d 2. With given number, n = 385 people. Person appreciated is 877 farmers usually contacting with pesticides in 385 households. 2.5.2. Sampling intervention studies - The sample size for intervention studies as follows: n = (Z 1- α/2 + Z 1 -β) 2 p1 q1 + p2 q2 (p1 - p2 ) 2 With given number, n = 90.16 (about 91 people). Take extra 20 % like this, sample size for each commune is 119 people. 2.6. Research design technique 2.6.1. Describing study Epidemiology research design describes cross sectional design in combination qualitative and quantitative 2.6.2. Intervention study Community intervention with comparison. 5 Intervention activities Communications: Combine direct communication with indirect communication with an aim to change behavior. Direct communication: Through training time, conference, practice guide. Especially, through club activity "Farmers - Small business- Medical staff". Indirect communication: On Media include many kinds and means. Examination of patients, drug treatment for some common diseases. Advise about health for pesticides user. Chapter 3 RESULTS Research 385 persons, we have the following results: 3.1. The current status of KAP about pesticides of tea cultivating farmer in Thai Nguyen (n = 385) Table 3.2. Pesticides using time basing on sex Sex 5-10 years > 10 years Total P n* % n % n % Male 47 12.2 134 34.8 181 47.0 >0.05 Female 63 16.4 141 36.6 204 53.0 Total 110 28.6 275 71.4 385 100 * n = Quantity Table 3.2 shows: Pesticides using time of above person over 10 years 71.4 %. Female (53.0 %) is more than male (47.0 %), p > 0.05. 6 Table 3.4 Knowledge of weather and wind direction chosen when spraying pesticides No. Content Know Unknown n % n % 1 Cool weather 351 91.2 34 8.8 2 Walking backwards 311 80.8 74 19.2 3 Downwind 171 44.4 214 55.6 4 Know fully 114 29.6 271 70.4 Table 3.4 shows: Know spray downwind low rate of 44.4 %, the rate is very low that a full 29.6 % Table 3.8. Know about health conditions to ensure the spray No. Health conditions to ensure the spray Know Unknown n % n % 1 Don’t spray when there are sick, pregnant, lactating 333 86.5 52 13.5 2 Older, children who do not go spraying 312 81.0 73 19.0 3 Periodic health examination 139 36.1 246 63.9 4 Not spraying over 2 hours/ day, two weeks/phase 98 25.5 287 74.5 5 Know fully 81 21.0 304 79.0 Table 3.8 shows that rate of farmers with full knowledge is very low (21.0 %). Rate of the elderly and children still use to pesticides (19.0 %) 7 Table 3.12. Pesticides mixed practice No. Pesticides mixed practice Yes No n % n % 1 Solider 50 13.0 335 87.0 2 Estimate 8 2.1 377 97.9 3 Mixture a kind 68 17.7 317 82.3 4 Mixture > two kinds 317 82.3 68 17.7 5 Exact mixture 67 17.4 318 82.6 Table 3.12 shows that mixture rate of many kinds of pesticides when spraying is very high (82.3 %), rate of farmers exact practice mixed pesticides the guide is very low (17.4 %). Table 3.13. Practice using personal protective equipment No. Use personal protective equipment Yes No Quantity % Quantity % 1 Mask 355 92.2 30 7.8 2 Glove 208 54.0 177 46.0 3 Protective clothes 263 68.3 122 31.7 4 Hat 246 63.9 139 36.1 5 Glasses 46 11.9 339 88.1 6 Full use 25 6.5 360 93.5 Table 3.13 shows that: rate of farmers spraying and using mask is very high (92.2 %). The lowest rate is glasses use (11.9 %), rate for use all kinds of personal protective equipment is very low (6.5 %) 8 Table 3.16 Information supply resource No. Information Supply Resource Yes No Quantity % Quantity % 1 Medical staff 263 68.3 122 31.7 2 Plant Protection Officer 37 9.6 348 90.4 3 Pesticide seller 226 58.7 159 41.3 4 Radio 158 41.0 227 59.0 5 Newspaper 94 24.4 291 75.6 6 Televisions 223 57.9 162 42.1 Table 3.16 shows that high rate of Information supply resource is Medical staff (68.3 %), pesticides seller (58.7 %) Chart 3.4.Rate buyer's guide seller use pesticide and poisoning prevention Not guided, 16.6% was guided; 83,4% Was guided Not guided 9 3.2. Health situation and some factors related to the health of people regularly exposed topesticides - The most muscle symptoms of farmers contacting with pesticides during the last time is nervous system, digest. Some popular symptoms such as tiredness (77.9 %), headache (73.1 %), dazzle, vertigo (78.4 %. Some disease groups with high rate such as diseases about nose and sore (86.9 %), eyes (84.8 %), bone muscle (63.7 %), skin (40.1 %), etc. - The risk is due to: unsafe pesticides mixture, solider pesticides mixture than guide, mix many kinds of pesticides in the spray related to disease nose and throat, increased 2.66 times compared with the correct mixture. - The risk to spraying the windward with nose and sore diseases is 2.55 times more than right the wind direction pesticides - The risk of going on with disease due to unsafe medicine mixture is 2.31 times more than right mixture. The risk of having eye disease due to spraying wind ward increases 3.27 times more than using glasses. 3.3. Results of intervention studies 3.3.1. Intervention activities - Build Project implement leading committee, propose commune People Committee to set up "Farmers - Small business - Medical staff" club basing on links between “Farmer – The sale of pesticide – commune Medical staff”, keep the club once three months. - Organize three training classes for main officers to take charge of the program, organize 14 training days at village (a day for each village) with 856 participants. - Celebrate 02 conference days at commune People Committee with 397 participants. 04 training days at the edge. - Deliver 1000 books: “Chemicals are used for agriculture and community health”. Deliver handout to all 1469 households. Propagandizing on media of commune (259 days). 10 - All 6 commune Medical staff are trained again about against pesticides poison. Project Steering Committee combining with Commune People's Committee managing pesticide suppliers, vendors. - Every month, Management committee meets "Farmers - Small business - Medical staff" to appreciate results and withdraw experiments for activities in month and build next solution. Table 3.21. Synthetic training, communication activity No. Activity content Subjects Times People 1 Steering Committee meeting Steering Committee 24 381 2 Communication skills training Collaborator, pesticides seller, commune Medical staff 3 96 3 Train for commune Medical staff Commune officer 3 17 4 Workshop (session) Commune People committee and study subjects 2 297 5 Training at village Farmers 14 856 6 Practice in the field Study subjects 4 472 7 Club activities Club members 8 208 Activity to protect health when exposure with pesticides - Organize periodical medical examination, advisory and care for human health on using pesticides, discover health problems at farmers exposed to pesticides. Keep clinic to discover health problems at Tan Linh commune health station. Test quantitative blood samples enzyme cholinesterase. 11 - Supply medicine to treat free for patient; advisory and introduction to go to treat heavy diseases. - Celebrate summary conference to appreciate effectively model "Farmers - Small business - Medical staff". 3.3.2. Effect of interfere solutions at Tan Linh Table 3.22. Knowledge of Medical staff and pesticide sellers Target Pre- intervention Post- intervention n % n % 1. Medical staff (n = 6) Be trained 0 0.0 6 100.0 Know to treatment pesticide poisoning 3 50.0 6 100.0 Know poisoning prevention advice 4 66.7 6 100.0 Know to guide how to use, reserve 2 33.3 6 100.0 2. Pesticide sellers (n=4) Be trained 0 0.0 4 100.0 Know poisoning prevention advice 1 25.0 4 100.0 Know to guide how to use, reserve 3 75.0 4 100.0 Having business registration 2 50.0 4 100.0 Table 3.22 shows that: - Before the intervention, no Medical staff and pesticides seller is trained. - After the intervention, 100 % pesticides seller and Medical staff know how to use, storage as well as prevention of pesticide poisoning. - The number of stores selling pesticides already registering business increases by from 50 % to 100 %. 12 Table 3.32. The result oftesting is comparition about active Enzym Cholinesterase (Normally 5,300-12,900U/L). Index Tan Linh Phuc Linh Pre-intervention n=60 (1) Post- intervention n=51(2) Test 1st n=60(1) Test 2nd n=51(2) n % n % n % n % <5300U/L 5 8.33 1 1.96 4 6.66 6 11.76 X ± SD 6744+ 1175 8800+2206 7324+1966 8354+2995 P1.2 0.05 Result of Table 3.32 shows that: - At Tan Linh after 2 years intervention activity enzyme cholinesterase average has increased. The ratio of person who has actived enzym below normal standard decreased from 8.33 % to 1.96 %. - At Phuc Linh the ratio of person who has active enzym below the normal standard will have tendency increasing (from 6.66 % to 11.76 %). Table 3.33. Comparing result test of pesticides in tea before and after intervention about all kind pesticides/01 sample and some kinds of pesticides average/01 sample Kind of pesticides /01 sample Tan Linh Phuc Linh P Pre- intervention n= 15 Post- intervention n=15 First test n=15 Second test n=15 Most 15 13 13 15 >0.05 At least 5 4 2 2 Average pesticides/01 sample 6.46 5.80 6.00 6.86 <0.05 13 Result of Table 3.32 shows that: Total all kind of chemical noxious is average to discovery on 01 sample at Tan Linh has decreased from 6,46 kinds /sample to 5,80 kinds /sample Meanwhile at PhucLinh increase from 0,6 kind/ 01 sample to 6,68 kinds/sample. The difference is statistically significant p <0.05. Table 3:37. Really effective for KAP's growing up tea exposure to pesticides after 2 years of intervention at Tan Linh Group The specific targets Index. Effective Interven -tion % Index. Effective Control % Interve -ntion effect % Know -ledge Knowing the treatment of poisoning 88.7 22.1 66.6 Knowing full kind of PPE 74.8 19.2 55.6 Know the health conditions when spraying 64.9 9.5 55.4 Understanding the colour on the pack 67.1 13.5 53.6 Understanding how to mix pesticide 56.0 3.7 52.3 Know how maintenance and storage 64.5 16.7 47.8 Understand how to spray 72.0 25.1 46.9 Understand the purpose of (P) use 52.3 17.0 35.3 Know the way into the body 43.6 15.4 28.2 Know the harmful effects of (P) 36.9 14.5 22.4 Know the symptom of poisoning 44.1 22.6 21.5 Attitu -de Interesting to wind direction 10.9 3.5 7.4 Needed to use PPE 3.4 0.8 2.6 Worried poisoning when exposed (P) 2.6 2.5 0.1 Practi -ce Mix pesticide correctly 72.1 10.6 61.5 Spraying pesticides correctly 46.7 2.6 44.1 Using full of PPE 88.0 60.5 27.5 Don’t allow to use pesticide forbid 23.1 10.1 13.0 Result of table 3.37 shows that: After 2 years intervention, model of education to prevent from noxious of pesticides to give clear result, knowledge and practicing has raised, knowledge of intervention effect to achieve 66,6 % and practicing has raised to 61,5 % achieve too. 14 Table 3.38. Really effective for health of person who growing up tea contacts with pesticides after 2 years intervene at Tan Linh. Group The specific targets Index Effective Intervention % Index Effective Control % Intervention effect % Functi- onal sympt- oms Increased salivation 63.4 8.4 55.0 Nausea 55.3 4.4 50.9 Muscle weakness 53.3 8.4 44.9 Easy to stimulus 43.5 2.6 40.9 Dry throat 40.7 0.0 40.7 Itchy Skin 34.9 5.6 38.3 Watery eyes 39.7 1.8 37.9 Blurred vision 39.0 2.8 36.2 Shake hands, feet 38.2 3.3 34.9 Vertigo, dizziness 34.9 0.1 34.8 Cough 35.0 1.5 33.5 Insomnia 32.9 1.2 31.7 Supine 31.8 1.0 30.8 Headache 36.0 8.4 27.6 Fatigue 29.5 3.5 26.0 Diseas- ed entity Urology 60.3 5.1 55.2 Respiratory 61.4 9.3 52.1 Eyes 52.3 8.8 43.5 Musculoskeletal 39.9 4.0 35.9 Nasopharyngeal 42.6 7.8 34.8 Dermatology 45.5 12.1 33.4 Cardiology 35.8 13.8 22.0 Neuropsychiatric 30.6 14.9 15.7 Digestive 21.8 7.0 14.8 Comments: 15 Result of table 3.38 shows that after 2 years intervene the ratio of disease has decreased, health of person who using of pesticide has improved. Intervention effect is the highest 55 % (increased salivation), the lowest has achieved 14,8 % (digestion) Chapter 4 DISCUSSIONS 4.1. Knowledge, attitude, practice (KAP), use, preservation and prevention of pesticide poisoning of tea cultivation 4.1.1. Some characteristics of study object By studying 385 subjects, we realize that secondary education accounted for 76.6 %, 13.5 % high school, elementary only 9.9 %. There is no illiteracy. Therefore, training, coaching, counseling of knowledge of pesticide poisoning prevention becomes easier to acquire. About sex, male makes up lower rate than female (female accounts for 53 % and male 47 %). A concern is that the percentage age of female having time to use pesticide more than 10 years accounts for higher proportion than male. In the study results, we can find that some one at the age of 20 years have exposure to pesticides for 5 years. That means that they sprayed pesticides at the age of 15 years. Interviewing Mr Tran Dinh D…, Health Station Chief says: “Some old people often have to spray Pesticides because their children work far away. At hamlet 7, Mr Hoang Quoc A.. at the age of 79 years and Mrs Le Thi H…at the age of 74 years still must spray pesticides”. This is the matter about which public health must care more in examining periodic health and health protection for people here. 4.1.2 KAP use, preservation and prevention of pesticide poisoning Knowledge, practice about using, preservation of pesticides is low. Most of KAP index does not reach 50 %. The majority of tea cultivator have active attitude to using pesticides (account for over 90 %), this is an important reason which can help intervention model be 16 successful. The public’s good attitude to preventing pesticide poisoning can help the model be feasible and the model is preserved sustainable in the community. Supply source of information to the public about how to use, maintain, and prevent toxic account for high proportion: (68,30 %) from medical staff, 58,7 % from seller of pesticides. This is the point which the research group chooses as breakthrough point, impacting on correct subject in the direct communication activities. 83,4 % age of buyer is guided how to use by the seller. However, they just receive poor information such as the way to choose the suitable one for each kind of tree, kind of pestilent insect. The store owner’s knowledge is limited; moreover, the source of information which they supply to customer is poor. Normally, they just introduce what kind of pesticides is suitable with the pestilent insect correlatively. They don’t grasp the knowledge of using pesticides especially poor knowledge of how to prevent toxic of pesticides. There is a lack of communication documents. Ms Nguyen Thi Th….at the age of 39 in hamlet 6, Tan Linh, the shop owner of pesticides shows that: “Most of people who come here to buy pesticides are always guided how to use, however, normally buyers just ask that their tea plant infected this kind of pestilent insect or other one, so what kind of pestilent insect they have to buy. Few people ask how to prevent poisoning. If they ask, we don’t understand to explain to them”. 4.2 Health situation of people who cultivate tea Some expressions such as being dizziness, vertigo accounts for 78.4 %, fatigue rate is 77.9 %, and headache rate is 73.1 % (table 3.17). The remarkable thing is the expressions of disease entities in some organs. Eye disease (84.8 %), nasopharyngitis (86.9 %), musculoskeletal joints (63.7 %), neuropsychiatric (51.1 %) (table 3.18). 4.3. Problem identification and intervention modeling to prevent pesticide poisoning and the effectiveness of interventions 17 4.3.1. Identify intervention problems and build the model From above analysis result, we choose the solution and build intervention model. The name of model: "Prevention of pesticide poisoning", some technical measure in intervening: This study used both direct and indirect communication which changed action, combined with periodic medical examination to detect, and to treat some diseases relating to pesticides. Some of the newest tendency and method: Linking between the users of pesticides (Farmer), traders of pesticides (Small business), and health workers (Medical staff). We call as "Farmers - Small business - Medical staff”. In this topic, we choose breakthrough point into the key stage is the main reason of the matter for highly effective selective and important intervention. - The Farmers exposed to pesticides are subject to interventions for changing benefit action to health and is also object need examining, management and taking care of health. - The seller of pesticides need to intervene to interventions the knowledge, counseling skills and is a direct communicator most effectively to usage, storage of pesticides. In fact, 83.4 % of buyers are guided how to use pesticides by sellers. - Medical staff are subject necessary to intervene to improve capacity of the treatment of poisoning and counseling skills. Also a direct communication are most effective for the prevention of pesticide poisoning. 4.3.2. The effect of intervention method The effectiveness of intervention method changes KAP of pesticides user. After intervening 2 years, the public’s knowledge has been improved remarkably. The Index Effective obtains from 36.9 % to 88.7 %. The actual effect is between 21.5 % and 66.6 % (table 3.37). Most of farmers's knowledge has been improved above 20 % in comparison with that before intervention. 18 Active attitude to supporting the use of workwear and poison prevention reach 100 %. This is a convenient factor which can help project be successful. The rate of the public who practices in a true way, has been improved significantly after intervening 2 years and efficiency indicator achieves from 23.1 % to 88.0 %. Actual intervention effectiveness is from 13.0 % to 61.5 %. Comparing the effectiveness of intervention method at Tan Linh and Phuc Linh commune is different significantly (p <0.05). The effectiveness of intervention method of improving people’s health who cultivate tea plant. Overall the rate of functional symptoms were significantly, more than 25.0 % comparing with that before intervention (p<0,05). Headache decreased from 84.0 % to 53.8 % from 82.4 % fatigue down 58.1 %, dizziness from 86.6 % to 56.4 %, trembling limbs from 70.6 % to 43.6 %, irritability from 52.9 % to 29.9 % (table 3.35). In comparison index of effective intervention group (29.5 % to 63.4 %) and control group (0 % to 8.4 %), we can see that index of effective of intervention group is higher than that of control group. Actual intervention efficiency is from 26.0% to 55.0% (Table 3:38) Entity diseases of nose - throat decreases from 84.9 % to 48.7 %, for eyes disease, there is a decrease from 95.0 % to 45.3 %. In our opinions, correct practice rate of intervention group has been improved. The use of mask and protection glass limits the penetration of pesticides into body. Besides, the intervention group usually examines and treats disease at once; therefore, the disease rate of intervention group is lower than that of control group. Through the result in table 3.38 we can see that the disease rate decreases after intervention. Actual intervention efficiency achieves 14.8 % to 55.2 %. To sum up, the initial target of project meets and exceeds the target. 4.4. Retention ability and model expansion 4.4.1. Feasibility and sustainability of the model 19 - Suitable model with Policy guidelines of Party and State towards agriculture, farmer and rural, farmer’s health is interested in by whole society. Local Communist Party and Government supported intervention model. Commune government committed to maintaining and to promoting the effect of model “"Farmers - Small business - Medical staff” in which the core of activities is Commune Medical Staff, and pesticide sellers especially the response of farmers. - Intervention model linked the relationship among Farmer - Small business and Medical Staff. Through training courses and conference, trader of pesticides and local medical staff know the communication skills of health education, and know how to use PPE and means of preventing poison of pesticides. After being trained, the farmer can grasp basic knowledge of preventing pesticide poisoning and especially their trust in trader of pesticides and local medical staff. They are willing to exchange their difficulties when using pesticides to pesticides sellers and local medical staff. - This intervention model “simply but effective” is easy to deploy in a large scale, the resource don’t need to be fit too much with economic condition in mountainous and highland area. The model has overcome some limitations that some previous encounter model is required enormous resources, the apparatus complex operations, while pouring money into the best result, project completion no pouring money the model is not sustainable, does not exist. - Sustainability of model: Because operation of model brings benefit for 3 factors which create the model: the farmer know how to prevent pesticide poisoning, reduce the number of cases, reducing the time hospital stay, hospital charges... especially health are guaranteed, this is the most precious property. When they are healthy, they can generate wealth for themselves and for society, get rich and contribute to their poverty reduction in particular and community in general. Traders of pesticides sell a great deal of pesticides because the people believe in only buying pesticides to their stores. Local medical staff finishes the plan of taking care of and protecting the public’s health, contributing to the successful implementation of local society - economic indicators, improving the living quality for rural people. 20 The result of model is a clear proof to convince local leaders and farmers to use pesticides. The above basic factors help the model succeed and keep up the model’s sustainability. 4.4.2. The new points of the dissertation - The dissertation gave indicator of KAP and structural disease of farmer growing tea in Thai Nguyen. Particularly the model building intervention to protect the health of farmers growing tea first fit the characteristics of mountain areas. That model is based on three factors cohesion "Farmers - Small Business - Medical staff". - The model “Farmer- Small Business - Medical Staff” is a new discovery of innovative approaches. This is the first model to be deployed in communities to improve the health of farmers growing tea, the analysis highlights selected for intervention and key interventions. Model found the dialectical relationship between objective "Farmers - Small Business - Medical staff". Farmers need Medical staff and pesticide sellers, and to reverse the pesticide sellers and Medical staff need farmers. Organic relationship and this has helped dialectical topics implemented smoothly and successfully. Especially the later stages to maintain the sustainability of the model. CONCLUSION 1. KAP actual situation of the farmers growing tea - The tea cultivator’s knowledge of pesticides: Full understanding of the effects of pesticides rate was 37.9 %, full understanding of harmful of pesticide makes up 50.1 %. Understanding how to choose weather and wind direction when spraying was 29.6 %, full understanding how to keep safely makes up 24.4 %. Understanding how to read the warning of toxic level through color bars on drug labels accounts for 14.5 %. Understanding the way of penetrating of pesticides into body makes up 40.5 %. Understanding of the necessity to ensure the health pesticides reached 21.0 % Know all the symptoms of pesticide poisoning 22.6 %, and know the treatment of pesticide poisoning by 5.5 %. 21 - The tea cultivator’s attitude to using pesticides: 97.4 % of them are worried about their health when spaying pesticides, 98.7 % of user of pesticides said that it is necessary to use personal protective equipment.. - Practice of using pesticides: Mix up many kinds of pesticides into a bottle when spray is 82.3 %. Full usage of personal protective equipment accounts for 6.5 %. Buy and use pesticide banned from use by 17.1 %. Handling containers after use: throw haphazard or reuse 21.9 %. - Sources of information for people on how to use, preservation and prevention of poisoning a high proportion is 68.3 % from health workers, 58.7 % were from the pesticides sellers. 2. Effects of pesticides to farmers' health - Rates of some functional symptoms: dizziness, vertigo is 78 %, fatigue is 77.9 %, headache is 73.1 %... (table 3.17). - The rate of some disease entities: Eye diseases is 84,8 %, nasopharyngitis is 86.9 %, osteoarthritis is 63.7 %, neuropsychiatric is 51.1 %, dermatology is 40.1 %... (table 3.18). 3. The effectiveness of intervention model - After intervening two years, the public’s knowledge has been improved remarkably, the rate of efficiency indicator obtains from 36.9 % to 88.7 %. Efficiency actually achieved after intervention from 21.5 % to 66.6 %. The rate practice the correct have improved remarkably, achieving efficiency index from 23.10 % to 88.0 %. Effective actually reach from 13.0 % to 61.5 %.. (table 3.37). - Some funtion symptoms as well as entity diseases in those who exposed to pesticides decrease considerably after intervention, especially symptoms of headache reduce from 84.0 % to 53.8 %, fatigue decreases from 82.4 % to 58.1 %, dizziness decreases from 86.6 % to 56.4 %, limb trembling reduces from 70.6 % to 53.8 %. Disease entity in nose - throat reduce from 84.9 % to 48.7 %, eyes diseases decrease remarkably (95.0 % to 45.3 %). Actual intervention effectiveness is from 14.8 % to 55.2 % (table 3.38). 22 - There is so much improvement in enzyme cholinesterase active of intervention group, and the rate decreases below the average at 1.96 %, while control group still reduces below average at 11.76 %. There is a significant difference between intervention group and control group (p<0.001). - The local medical staff’s capacities has been improved, especially communication skills poisoning prevention, examination, find out and treatment symptoms poisoning pesticides. Propagator introduces trader of pesticides in model and guides the farmers to use, preservation and prevention of poisoning pesticides. (table 3.32). - Leaders of the Party Committee, People’s Committees of Commune and farmers high appreciate and accept to maintain the model after the project ends. RECOMMENDATIONS Based on these results we have a number of recommendations follows: 1. Base on “Farmers - Small Business - Medical staff” model, local party and government at Tan Linh commune - Dai Tu District - Thai Nguyen Province invest the labor resources; keep up Intervention Model of communication education of occupational safety in maintaining and preventing poison of pesticides. 2. Expand the model to all district and other tea growing areas, trial research of model in other tea growing areas such as: rice, vegetable and crops. 3. Health sector need to develop program and organize to examine and manage public health periodically. Enhancing to train for medical staff in prevention and treatment of diseases related to Pesticides. Early detection of pathological disorders related to insecticide treated promptly.

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