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:

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

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 m

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

p
1
q
1
+ p
2
q
2

(p
1
- p
2
)
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

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

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

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.


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

nd

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 < 0.001 >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

pesticides after 2 years of intervention at Tan Linh
Group The specific targets Index.
Effective

Interven
-tion %
Index.
Effective

Control
%
Interve
-ntion
effect
%

Know
-ledgeKnowing 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



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

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

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.

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

- 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

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.