Hanna-Andrea Rother

Pesticide safety training and practices in women working in small-scale agriculture in South Africa

Objectives Unregulated use of pesticides continues in developing countries in the presence of illiteracy and limited safety training and practices. This paper describes training and safety practices when mixing and spraying pesticides, and acetylcholinesterase levels among women farmers in KwaZulu-Natal, South Africa. Methods A cross-sectional study conducted in women working in small-scale agriculture in rural KwaZulu-Natal, South Africa in 2006 assessed pesticide training and safety practices using a questionnaire survey and measured acetylcholinesterase levels in 803 women. Three components of safety behaviour were identified through principle component analysis and described. Results The mean age of participants was 41.8 years (range 18–82 years) with a mean of 6.9 years (range 1–12 years) of education among school attendees. Among the 803 women included, 366 (45.6%) were the primary sprayers on their farm. Only 16.4% of the sprayers had ever attended a pesticide training course and only 18.0% reported ever reading pesticide labels. Of the women using some form of protective equipment, 56.7% and 54.9% reported doing so when mixing and spraying pesticides, respectively. The mean acetylcholinesterase level corrected for haemoglobin among study participants was 28.9 U/g Hb (95% CI 28.4 to 29.4). Conclusion Women working in small-scale agriculture in rural KwaZulu-Natal with limited access to pesticide training observe few safety practices when mixing and spraying pesticides.

Pesticide poisonings at a tertiary children's hospital in South Africa: an increasing problem

Context. Exposure of children to pesticides and overt poisoning are an increasingly important problem in South Africa. Objective. This study describes the profile of acute paediatric pesticide exposures and poisonings presenting to Red Cross War Memorial Childrens Hospital (RCWMCH) in Cape Town South Africa from 2003 to 2008, identifies those poisonings due to illicit pesticides sold on the streets (“street pesticides”) and assesses the number of incidents in which the statutory requirement of notification to the local health authority is met. Methods. Cases were identified by review of the RCWMCH case and notification records and the local health authority notification records. Results. There were 306 patients with 311 incidents of acute pesticide exposure or poisoning. This represents 11% of all paediatric exposures and poisonings (N = 2868) seen over the 6-year period. The number of pesticide incidents increased annually. Two hundred seventy-eight (91%) children were under 6 years old and 164 (54%) were males. Two hundred seventeen (70%) patients came from six socio economically diverse suburbs in the Cape Town Metropole, each of which ranges from informal settlements with extreme poverty to formal housing with lower to middle class populations. There was a summer predominance of acute pesticide exposures and poisonings. The commonest group of pesticides were 203 cholinergics (includes organophosphates and carbamates), 35 anticoagulants and 45 unknowns. One hundred incidents were classified as exposures as they were asymptomatic. Two hundred eleven symptomatic incidents, termed pesticide poisonings, required admission; 121 to High Care or Intensive Care Unit (ICU). The median length of stay in hospital was 3 days (range 0–52). There were 6 (2%) deaths. The large group of cholinergic exposures and poisonings (203) required 195 (96%) admissions; 120 (59%) to High Care or ICU. Of the 44 “street pesticide” exposures and poisonings, 33 were cholinergic poisonings and 21 required High Care or ICU. Eighty-seven (41%) of 211 poisonings requiring notification were recorded at the local health authority; all were instances of cholinergic poisoning. Conclusion. The increasing number and the morbidity and mortality of acute paediatric pesticide exposure and poisoning is of great concern. Furthermore, the magnitude of the problem is masked by inadequate notification with the relevant health authorities.

Pesticide use among emerging farmers in South Africa: contributing factors and stakeholder perspectives

The commercial agricultural sector in South Africa has historically been dominated by large-scale operations run by white owners and managers. In redressing this imbalance, black farmers classified as ‘emerging’ are being encouraged to engage in high-input agricultural production in order to obtain ‘commercial’ status. Since existing practices in commercial agriculture rely heavily on pesticides, emerging farmers aspiring to become commercial are pressured to adopt and/or increase the use of pesticides. However, problems of access to land, finances, resources, skills and markets overshadow the health and safety of these farmers and their labour force that may be affected by exposure to pesticides. This paper presents the results of a policy study based on primary interview data with key stakeholders and secondary documentary review data, to illustrate how pesticides are used in an occupational health and safety vacuum because the focus of key institutions is rather on economic productivity.

People, Pesticides, and the Environment: Who Bears the Brunt of Backward Policy in South Africa?

Whereas international trends show that many developed countries are adopting policies that promote pesticide reduction, use of pesticides in South Africa continues to expand. In particular, macroeconomic policies encourage pesticides use among emergent small-scale black farmers, while potential exposures of workers on commercial farms remain high. Despite having legal controls that seem to conform to international standards, the present health and environmental impacts of pesticide use in South Africa are substantial and generally underestimated. The reasons lie in the fragmentation of regulatory mechanisms as well as the absence of public awareness and participation in policy-making related to pesticides. Failure to enforce existing legislation, an ambivalent relationship between government and industry, and the existence of a “pesticide culture” will continue to prevent implementation of meaningful control measures. As a result, it is marginalized groups, such as small-scale farmers and farm workers, who bear the brunt of policies that have not kept pace with a growing international awareness of the hazards of widespread pesticide use for human health and for the environment. Opportunities for fundamental transformation of the legal and policy framework relating to pesticides in order to promote environmental justice are explored.

'Read this and be safe!' Comparison of regulatory processes for communicating risks of personal care products to European and South African consumers

BackgroundMost personal care products (PCPs) contain hazardous ingredients, but current legislation in the European Union (EU) and South Africa (SA) does not require these to be labelled as hazardous products. Instead, ingredients must only be listed on containers to inform consumers of potential hazards. We assessed whether current legal strategies provide the means for effective risk communication (RC) mechanisms for PCPs in order to protect consumers’ health and the environment.Results and conclusionsRC strategies used in developed countries are not necessarily better compared to developing countries despite the existence of extensive legislation in the former. Socio-cultural factors, scientific literacy and language differences are key reasons why the current ingredient lists on PCP labels are not an effective RC strategy. The assumption is that consumers will interpret the risks of these ingredients by conducting a risk assessment for their personal context. Realistically, the following risk mitigation measures should be implemented in developed and developing countries to reduce the public’s potential exposures to hazardous substances: substitute hazardous ingredients with less hazardous; provide accessible mechanisms for consumers to comprehend RC measures; delete the exception clause in the EU Regulation on Classification, Labelling and Packaging (CLP); apply clear mandatory labels where PCPs health risks are clearly illustrated; and increase enforcement of legislation.The high incidence of fragrance allergies caused by PCPs is one example illustrating how current legal measures in the EU and SA fail to protect consumers and the environment from hazardous exposures. Therefore, efforts must be made to improve legally required RC measures.

Communicating pesticide neurotoxicity research findings and risks to decision-makers and the public

The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audiences varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.

Child's play : Exposure to household pesticide use among children in rural, urban and informal areas of South Africa

BACKGROUND As part of a larger dermatological investigation undertaken in 1999 - 2001 involving the Department of Dermatology, Groote Schuur Hospital (Cape Town, South Africa) and Nottingham University (UK), household pesticide use was investigated among Xhosa-speaking families living in three areas in South Africa (a rural area, an urban township and an informal settlement). OBJECTIVES The aim was to characterise pesticide use patterns and potential exposures through skin absorption, ingestion and inhalation for this group of South African children. METHODS A standardised questionnaire, which included a section investigating household pesticide use, was administered by four trained fieldworkers to the parents/guardians of the 740 children (25%) aged between 3 and 11 years identified as having atopic dermatitis either by clinical examination or according to the UK criteria (rural N=387, urban N=292, informal N=61). RESULTS Of the children with atopic dermatitis, 539 (73%) had been exposed to household pesticides. Most childhood exposure (89%) occurred in the informal settlements, followed by 78% in the urban area and 63% in the rural area. CONCLUSIONS This research highlighted considerable home environment pesticide exposure of South African children in lower socio-economic groups in rural, urban and informal areas. As children are particularly vulnerable to the short- and long-term health effects of pesticide exposure, further in-depth investigation is needed to ascertain and document the health effects associated with such exposure in the home.

A Qualitative study of language barriers between South African health care providers and cross-border migrants

BackgroundCommunication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation.MethodsAs part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically.ResultsZimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters.ConclusionAlthough there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation.

The acceptability of rat trap use over pesticides for rodent control in two poor urban communities in South Africa

BackgroundRodent infestations are a public health problem in poor urban communities. The use of illegal street pesticides to control rodent infestations with resulting poisonings is an additional public health concern receiving limited attention in many developing countries, including South Africa.MethodsParticipants in a household intervention in two poor urban areas of Cape Town, South Africa, received two high quality rat traps. Reported in this article are the results of a follow-up survey conducted six months after distribution to assess community perceived acceptability of using rat traps instead of toxic pesticides (N = 175).ResultsOf the 175 respondents that were followed up, 88% used the traps and only 35% continued using pesticides after the intervention. The analysis identified perceived effectiveness of the traps (prevalence odds ratio 18.00, 95% confidence interval 4.62 to 70.14), being male (prevalence odds ratio 8.86, 95% confidence interval 1.73 to 45.19), and the willingness to buy traps from an informal market (prevalence odds ratio 17.75, 95% confidence interval 4.22 to 74.57) as significantly associated with the acceptance of trap use.ConclusionsRat traps, when introduced to poor urban communities, are acceptable as an alternative to toxic pesticides for rodent control. Sustainability of trap use, however, needs to be researched, especially cost and cost-benefit.

Improving poisoning diagnosis and surveillance of street pesticides

An effective surveillance system is required to reduce pesticide exposures and poisonings, especially from street pesticides (illegal, unlabelled, and decanted agricultural pesticides used predominately for urban household purposes). Poisoning from any pesticide class, not only organophosphates, constitutes a medically notifiable condition in South Africa. Current practice, however, is to report only organophosphate cases, resulting in severe under-reporting. The lack of data concerning the link between poisonings and street pesticides has led to the mistaken assumption that urban populations are not at risk from significant pesticide exposures and poisonings. Without accurate statistics, healthcare professionals and policy makers are unaware of the contribution of street pesticide poisonings to the overall health burden. Accurate diagnosis is a prerequisite for notification and subsequent surveillance. An algorithm has been developed to enable healthcare professionals to improve the diagnosis and notification of pesticide poisonings.