Self reported symptoms and inhibition of acetylcholinesterase activity among Kenyan agricultural workers.

OBJECTIVES: This study was part of the East African pesticides project. The general objective was to assess health hazards posed by handling, storage, and use of pesticides, on agricultural estates and small farms with a view to developing strategies for prevention and control of pesticide poisoning. The aim of this paper is to describe the prevalence of symptoms in this population, to relate levels of inhibition to reported symptoms and evaluate at which levels of inhibition symptoms become increased. METHODS: Complete data were available for 256 exposed subjects and 152 controls from four regions in Kenya. A structured questionnaire on symptoms experienced at the time of interview was given to all subjects and controls. Information was also obtained on sex, age, main occupation, and level of education. Symptoms reported during the high exposure period, were initially clustered in broader symptom categories from reference literature on health effects of pesticides that inhibit cholinesterase (organophosphate and carbamate). Prevalence ratios were estimated for symptoms with changes in cholinesterase activity in serum. RESULTS: Symptom prevalence in exposed subjects was higher during the high exposure period than the low exposure period, although these differences were not significant. Interestingly, a clear and significant change in symptoms prevalence was found in the controls with a higher prevalence in the low exposure period. Analysis of the relation between cholinesterase inhibition and symptoms showed that prevalence ratios were significantly > 1 for respiratory, eye, and central nervous system symptoms for workers with > 30% inhibition. Similar results were found for analyses with the actual level of acetylcholinesterase activity. CONCLUSION: The results suggest the presence of a relation between exposure and acetylcholinesterase inhibition, acetylcholinesterase activity, and respiratory, eye, and central nervous system symptoms. Increased symptom prevalence was found at acetylcholinesterase activities generally considered to be non-adverse.

Identification of determinants of pesticide exposure among Kenyan agricultural workers using empirical modelling.

The influence of factors such as type of pesticides used, use of personal protective devices and hygienic behaviour on acetylcholinesterase inhibition and activity levels in red blood cells of agricultural workers was studied in four areas in Kenya. Empirical modelling techniques were used to identify and quantify factors affecting acetylcholinesterase inhibition and activity. Use of personal protective devices was almost non-existent in areas 3 and 4 where mainly subsistence farmers were studied. Differences in hygienic behaviour between areas were relative small. WHO Class I pesticides were mostly found in area 1 (mainly large farms growing flowers) which also had highest amounts of pesticide use and highest frequency of pesticide spraying. Despite widespread use of protective devices in this area significant inhibition occurred. It became unclear whether acetylcholinesterase inhibition occurred as a result of protective clothing soaked with pesticides, thereby increasing dermal exposure, or because of other (unmeasured) factors. Inhibition, however, could have been much worse without protective devices. In area 1, most workers wore boots, which were found to be protective only when combined with an overall; wearing boots alone led to increased inhibition. Access to a washing facility or bathing facility had a positive effect on acetylcholinesterase levels. However, washing of hands and bathing immediately after spraying seemed reactive behaviour rather than proactive behaviour. Spraying was found to lead to more profound acetylcholinesterase inhibition than mixing. Workers who sprayed WHO Class III pesticides had less acetylcholinesterase inhibition than workers spraying more toxic pesticides.