Pesticide safety behaviours among agricultural workers and farmers: A cross-sectional study.

AIM: The aim of this study is to investigate the pesticide safety behaviours and related factors among cabbage farmers in Kalaw Township, Myanmar. BACKGROUND: Unsafe chemical pesticide practices affect farmers' health and the environment. Understanding pesticide safety behaviours is necessary for healthcare providers to protect agriculture workers against unwanted adverse health effects. METHODS: The cross-sectional study was conducted among 195 cabbage farmers from March to May 2019. Safety behaviours and factors applied in the PRECEDE-PROCEDE model as a framework were assessed using questionnaires. Bivariate and multivariate logistic regression was applied to identify any associations. RESULTS: Altogether, 72.1% of the farmers had a low level of safety behaviours. Goggles and masks were rarely used before and during pesticide applications. All of the farmers experienced adverse health effects after using pesticides. The attitudes toward pesticide poisoning; support from family, co-workers and healthcare providers; and the availability of personal protective equipment were significantly associated with safety behaviours. CONCLUSION: Our data provide novel empirical evidence for an opportunity to design effective nursing interventions to promote pesticide safety behaviours among Myanmar agricultural workers. Nurses should pay more attention to promoting comprehensive interventions to reduce both exposure and health effects among agricultural workers through the involvement of supported stakeholders.

FACTORS ASSOCIATED WITH DIABETIC RETINOPATHY AMONG TYPE 2 DIABETIC PATIENTS: A HOSPITAL BASED CASE-CONTROL STUDY.

The objective of this study was to determine factors associated with diabetic retinopathy (DR) among type 2 diabetics in Thailand. We conducted a hospital based case-control study in Nakhon Nayok Province, between August 2008 and July 2010. The subjects were comprised of 230 cases (with DR) and 230 controls (without DR) who were gender and age matched. All subjects were interviewed and their medical records were reviewed. Seventy-five percent of subjects were married and 42% were aged 60-69 years. Fifty-five percent had a primary school education, 27% had no occupation and 67% had family income > 10,000 Baht per month. On multiple logistic regression analysis, factors associated with DR were: having a fasting plasma glucose (FPG) of 141-160 mg/dl, 161-180 mg/dl and > 180 mg/dl [OR = 7.23; 95% confidence interval CI: 2.80-18.72; OR = 4.33; 95% CI: 1.66-11.33, and OR = 3.76; 95% CI: 1.39-10.18], having a HbA1c > 9% (OR = 2.26; 95% CI: 1.15-4.43), having a BMI ≥ 30 kg/m2 (OR = 2.09; 95% CI: 1.04-4.19), and having hypertension (OR = 1.80; 95% CI: 1.19-2.71). Elevated blood sugar, blood pressure and body weight are all associated with DR. Further study is needed to determine if controlling these factors could reduce the prevalence of DR.

Exposure of Young Children to Permethrin and Cypermethrin Insecticides in the Residential Environment.

The aims of this study were to evaluate the exposure to permethrin and cypermethrin of young children aged between 2 and 5 years in Nakhon Pathom and Sing Buri provinces, Thailand. A questionnaire that included general demographic information, household characteristics, insecticide usage and exposure-related behavior in children was used to interview parents or family caregivers. Permethrin and cypermethrin concentrations on floor surfaces and children's hands, as well as their urinary metabolites, were analyzed by gas chromatography coupled with mass spectrometry. The results showed that permethrin and cypermethrin were detected in 62% and 83% of the children's hand wipe samples, with geometric mean (GM) levels of 0.02 µg and 0.04 µg, respectively. Permethrin and cypermethrin were detected in 79% and 93% of floor surface wipe samples, with GM levels of 0.90 µg/m2, and 1.49 µg/m2, respectively. For children's urine, the GM concentrations of cis- and trans-DCCA, 3-PBA, and total pyrethroid metabolites were 0.84, 0.31 and 1.23 nmol/g creatinine, respectively. This study found that household insecticide product usage and having a tile floor were associated with increased permethrin concentrations on the children's hands and floor surfaces. However, cypermethrin concentrations on floor surfaces were significantly higher in families using aerosol insecticide sprays and insecticide products in the living room and bedroom. The predictors of the total pyrethroid, DCCA and 3-PBA metabolites are permethrin on children's hands or floor surfaces and cypermethrin on floor surfaces.

Evaluation of Immunodiagnostic Performances of Neospora caninum Peroxiredoxin 2 (NcPrx2), Microneme 4 (NcMIC4), and Surface Antigen 1 (NcSAG1) Recombinant Proteins for Bovine Neosporosis.

Bovine neosporosis is among the main causes of abortion in cattle worldwide, causing serious economic losses in the beef and dairy industries. A highly sensitive and specific diagnostic method for the assessment of the epidemiology of the disease, as well as it surveillance and management, is imperative, due to the absence of an effective treatment or vaccine against neosporosis. In the present study, the immunodiagnostic performance of Neospora caninum peroxiredoxin 2 (NcPrx2), microneme 4 (NcMIC4), and surface antigen 1 (NcSAG1) to detect IgG antibodies against N. caninum in cattle were evaluated and compared with that of the indirect fluorescent antibody test (IFAT). The results revealed that NcSAG1 had the highest sensitivity and specificity, with values of 88.4% and 80.7%, respectively, followed by NcPrx2, with a high sensitivity of 87.0% but a low specificity of 67.0%, whereas NcMIC4 showed sensitivity and specificity of 84.1% and 78.9%, respectively, when compared with IFAT. A high degree of agreement was observed for NcSAG1 (k = 0.713) recombinant protein, showing the highest diagnostic capability, followed by NcMIC4 (k = 0.64) and NcPrx2 (k = 0.558). The present study demonstrates that NcSAG1 is helpful as an antigen marker and also demonstrates the potential immunodiagnostic capabilities of NcPrx2 and NcMIC4, which could serve as alternative diagnostic markers for detecting N. caninum infection in cattle. These markers may find utility in future treatment management, surveillance, and risk assessment of neosporosis in livestock or other animal host species. Further research should be directed toward understanding the in vivo immune response differences resulting from immunization with both recombinant proteins.

Urinary Cypermethrin Metabolites among Conventional and Organic Farmers in Thailand.

Cypermethrin, a pyrethroid insecticide, is frequently spread on agricultural farmlands and is also used in households in Thailand. Conventional pesticide-using farmers (n = 209) were recruited from the Phitsanulok and Nakornsawan provinces. Certified organic farmers (n = 224) were also recruited in the Yasothorn province. The farmers were interviewed via a questionnaire and the urine from their first morning void was collected. The urine samples were analyzed for 3-phenoxybenzoic acid (3-PBA), cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA), and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA). The results showed no significant difference in the urinary cypermethrin metabolites between the conventional farmers and the organic farmers, for whom the usage of cypermethrin was not accounted for. However, when conventional farmers who used cypermethrin on the farm and in the home were compared with conventional farmers who did not use any cypermethrin or with organic farmers, a significant difference was noted for all metabolites except for trans-DCCA. These findings show that the most significant exposures to cypermethrin are among conventional farmers who use the insecticide on their farms or in their homes. However, measurable levels of all metabolites were found among both conventional and organic farmers who only used cypermethrin in the home or not at all, suggesting that the at-home use of pyrethroids and other possible exposures from pyrethroid residues on market-bought food may contribute to urinary levels of pyrethroids that exceed those of the general population in the US and Canada.

Pneumonia, influenza, and dengue cases decreased after the COVID-19 pandemic in Thailand.

The coronavirus disease 2019 (COVID-19) pandemic has affected all healthcare systems worldwide. Effective COVID-19 preventive measures, including wearing a mask, hand washing, avoiding the "Three Cs", and city lockdowns, could decrease other infectious diseases. The case numbers of the major infectious diseases in Thailand were investigated (pneumonia, influenza, and dengue fever) during the COVID-19 pandemic using Thailand government national data sources from 2018 to August 2021. Pneumonia, influenza, and dengue fever cases decreased after the COVID-19 pandemic. In addition to respiratory tract infections, COVID-19 preventive measures could decrease dengue fever cases.

Knowledge, Attitudes, and Practices Regarding "New Normal" Guidelines and Quality of Life Among Thai People During the COVID-19 Outbreak: An Online Cross-Sectional Survey.

In Thailand, strict prevention and control strategies have been implemented to mitigate the rapid spread of coronavirus disease 2019 (COVID-19). "New normal" guidelines and a series of mobile health applications have been introduced by the healthcare sector and implemented to aid the disease control monitoring and prevention of widespread outbreaks. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding "new normal" guidelines and quality of life (QOL) among Thai people during the COVID-19 outbreak, and to determine the association between KA, QOL, and practices. An online cross-sectional survey was conducted from 7 June to 12 September 2021 among Thai people in Public Health Region 6 aged ≥ 18 years old. Of the 506 survey participants, 80.3% were female, and 65.0% were 25-59 years old. The survey revealed that 52.2% of participants were classified as having more accurate knowledge, 58.9% were classified as having more positive attitudes, and 80.8% were classified as having more frequent practices regarding "new normal" guidelines, and 54.7% had high QOL. Of the participants, 93.7% agreed that "people who have been fully vaccinated should wear a mask while outside," and 95.5% wore a face mask outdoors in crowded places. However, 60.9% of participants misunderstood some details regarding online applications for contact tracing and vaccination services, 44.2% felt that these applications were difficult to use, and 33.4% rarely or never downloaded or used these applications. In logistic regression analyses, accurate knowledge of COVID-19 was associated with higher education, being a government employee, monthly family income > 30,000 Thai Baht, and regular use of social media. More positive attitudes regarding "new normal" guidelines and high QOL were associated with positive practices. High QOL was associated with older age, and higher education. Enhancement of attitudes and QOL is also important for improving practices in the general population during the COVID-19 pandemic. Significant factors identified in KAP will be crucial for developing effective prevention and control programs to mitigate the spread of COVID-19. To implement mobile health applications effectively, more work is required to improve the ease of use and promotion strategies.

Prevalence, anti-malarial chemoprophylaxis and causes of deaths for severe imported malaria: A systematic review and meta-analysis.

BACKGROUND: There are limited data regarding prevalence, anti-malarial chemoprophylaxis, and causes of death for severe imported malaria. Thus, we conducted a systematic review and meta-analysis to characterise these variables. METHODS: We searched studies reporting deaths attributable to severe imported malaria. The following pooled prevalence rates were determined: 1) the pooled prevalence of severe malaria among patients with imported malaria, 2) the pooled prevalence of deaths among patients with severe imported malaria, 3) the pooled prevalence of anti-malarial chemoprophylaxis among patients with severe imported malaria, and 4) the causes of death among patients with severe imported malaria. RESULTS: The search identified 52 studies that were mainly conducted in Europe (25, 48.1%), North America (16, 30.8%) and Asia (7, 13.5%). The pooled prevalence of severe imported malaria was 12.5% (95% confidence interval [CI] = 10.3%-14.6%, I2 = 99.32%, 12393 severe cases/118325 imported cases). The pooled prevalence of deaths attributable to severe imported malaria was 5.1% (95% CI = 4.0%-6.2%, I2 = 91.72%, 721 deaths/16310 severe cases). The pooled prevalence of adequate anti-malarial chemoprophylaxis among patients with severe imported malaria was 9.7% (95% CI = 6.5%-13.0%, I2 = 89.9%, 203/2049 cases). The most common cause of death was multi-organ failure (12.3%). CONCLUSION: The results highlighted the need for education and preventative measures for travellers, immigrants, or workers who plan to visit malaria-endemic areas to minimize the risk of severe disease or death.

A scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region.

Antibiotic use (ABU) plays an important role in the proliferation of antimicrobial resistance (AMR). Global antimicrobial consumption in food production is projected to rise by 67% from 2010 to 2030, but available estimates are limited by the scarcity of ABU data and absence of global surveillance systems. The WHO South-East Asia (WHO SEA) region is at high risk of emergence of AMR, likely driven by intensifying farm operations and worsening ABU hotspots. However, little is known about farm-level ABU practices in the region. To summarize emerging evidence and research gaps, we conducted a scoping review of ABU practices following the Arksey and O'Malley methodological framework. We included studies published between 2010 and 2021 on farm-level ABU/AMR in the 11 WHO SEA member states, and databases were last searched on 31 October 2021. Our search strategy identified 184 unique articles, and 25 publications underwent full-text eligibility assessment. Seventeen studies, reported in 18 publications, were included in the scoping review. We found heterogeneity in the categorizations, definitions, and ABU characterization methods used across studies and farm types. Most studies involved poultry, pig, and cattle farms, and only one study examined aquaculture. Most studies evaluated ABU prevalence by asking respondents about the presence or absence of ABU in the farm. Only two studies quantified antibiotic consumption, and sampling bias and lack of standardized data collection methods were identified as key limitations. Emerging evidence that farm workers had difficulty differentiating antibiotics from other substances contributed to the uncertainty about the reliability of self-reported data without other validation techniques. ABU for growth promotion and treatment were prevalent. We found a large overlap in the critically important antibiotics used in farm animals and humans. The ease of access to antibiotics compounded by the difficulties in accessing quality veterinary care and preventive services likely drive inappropriate ABU in complex ways.

Association between hypertension and stroke among young Thai adults in Bangkok, Thailand.

A hospital based case-control study was conducted to assess the association between hypertension and stroke among young Thai adults at a private hospital in Bangkok, Thailand. The study population was comprised of 98 inpatients with a first diagnosis of stroke and 98 inpatients without stroke admitted from 2006 to 2008, aged 18-45 years. Cases were matched with controls by sex and five year age group intervals. Risk factors for stroke, including hypertension were collected using a questionnaire. Significant finding on physical examination and blood testing were obtained from the patients' charts. Multivariate analysis revealed significant risk factors for stroke were: diagnosis of hypertension (adjusted OR 8.94; 95% CI 1.47-54.34), family history of stroke (adjusted OR 16.15; 95% CI 1.71-151.82), history of no or irregular exercise (adjusted OR 8.06; 95% CI 1.12-57.60) and having a low high density lipoprotein level (adjusted OR 5.93; 95% CI 1.11-31.52). Hypertension was the greatest risk factor for stroke among young Thai adults. Modification of lifestyle to reduce risk for stroke should focus on exercise, regular health check-ups and adequate treatment of hypertension.

Effectiveness of a Weight Management Program Applying Mobile Health Technology as a Supporting Tool for Overweight and Obese Working Women.

This study aimed to evaluate the effectiveness of a weight management program applying mobile health (mHealth) technology as a supporting tool. A quasi-experimental research with a 1-group pretest and posttest design was conducted. Thirty-eight overweight and obese working women, aged 25 to 52 years, who were ready to take action on weight loss participated in a 12-week weight management program. Repeated-measures analysis of variance was used to examine the mean differences in related variables. The results showed that the mean weight and waist circumference of the participants significantly decreased from baseline to post-intervention (week 6) and follow-up (week 12; 72.2 ± 10.4, 71.6 ± 10.8, 71.4 ± 11.0 kg, P = .008, and 92.1 ± 10.1, 89.9 ± 9.9, 87.8 ± 10.7 cm, P < .001, respectively). Moreover, they had significantly improved self-efficacy for healthy eating and physical activity, eating behaviors, dietary intake patterns, and frequency of taking stairs. This weight management program was effective for the prevention and control of overweight and obesity.

Development of a loop-mediated isothermal amplification technique and comparison with quantitative real-time PCR for the rapid visual detection of canine neosporosis.

BACKGROUND: Dogs are the definitive hosts of Neospora caninum and play an important role in the transmission of the parasite. Despite the high sensitivity of existing molecular tools such as quantitative real-time PCR (qPCR), these techniques are not suitable for use in many countries because of equipment costs and difficulties in implementing them for field diagnostics. Therefore, we developed a simplified technique, loop-mediated isothermal amplification (LAMP), for the rapid visual detection of N. caninum. METHODS: LAMP specificity was evaluated using a panel containing DNA from a range of different organisms. Sensitivity was evaluated by preparing 10-fold serial dilutions of N. caninum tachyzoites and comparing the results with those obtained using qPCR. Assessment of the LAMP results was determined by recognition of a colour change after amplification. The usefulness of the LAMP assay in the field was tested on 396 blood and 115 faecal samples from dogs, and one placenta from a heifer collected in Lopburi, Nakhon Pathom, Sa Kaeo, and Ratchaburi provinces, Thailand. RESULTS: Specificity of the LAMP technique was shown by its inability to amplify DNA from non-target pathogens or healthy dogs. The detection limit was the equivalent of one genome for both LAMP and qPCR. LAMP and qPCR detected positive N. caninum infection in 15 of 396 (3.8%) blood samples; LAMP detected 9/115 (7.8%) positive faecal samples, while qPCR detected 5/115 (4.3%) positive faecal samples. The placental tissue was shown to be positive by both techniques. Agreement between LAMP and qPCR was perfect in blood samples (kappa value, 1.00) and substantial in faecal samples (kappa value, 0.697). CONCLUSIONS: This is the first known LAMP assay developed for the amplification of N. caninum. The technique effectively and rapidly detected the parasite with high sensitivity and specificity and was cost-effective. This assay could be used in the field to confirm the diagnosis of canine or bovine neosporosis.

Modified Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia for Thai elderly.

A potential test for early detection of dementia in the elderly is the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which is based on information from the informant for the elderly about the changes of the elderly in everyday cognitive functioning associated with dementia. The present study aimed to modify and assess the reliability and validity of the modified IQCODE consisting of 32 items. The study consisted of two methods of assessing dementia: DSMIV diagnosis carried out by clinicians, and informants responding to the IQCODE. The subjects were 200 pairs of elderly subjects and their informants who visited the Geriatric Clinic, Ramathibodi Hospital. The optimal cutoff score on the modified IQCODE was 3.42, with 90% sensitivity and 95% specificity. The positive predictive values, negative predictive values, and accuracy were 0.94, 0.90, and 0.92, respectively. The IQCODE items had high internal consistency. The IQCODE associated with the elderly person's age, but not with their gender and educational level; nor were they associated with the demographic characteristics of the informant. Therefore, the IQCODE could be used as an alternative screening test for dementia in Thailand with acceptable sensitivity and specificity. This tool may be useful for dementia screening in the community and the geriatric clinic for early detection of disease.

Family Planning Practice Among Rural Reproductive-Age Married Women in Myanmar.

A cross-sectional study was undertaken to investigate family planning (FP) practices and associated factors among reproductive-age married women. Data were collected by interviewing the 300 married women living in a rural area of Myanmar. The questionnaire had reliability coefficients ranging from .8 to .9. Results indicated that 73.3% of women performed FP, and contraceptive injection was the most common method. Significant associations were found with age 21 to 35 years (adjusted odds ratio [adj OR] = 3.748, 95% CI = 2.179-6.445), adequacy of income (adj OR = 2.520, 95% CI = 1.477-4.290), good attitude toward FP (adj OR = 0.386, 95% CI = 0.228-0.656), good support from health care providers (adj OR = 0.129, 95% CI = 0.054-0.313), good support from family (adj OR = 0.304, 95% CI = 0.163-0.565), good support from friends (adj OR = 0.344, 95% CI = 0.193-0.613), and FP practice. It is recommended that designing FP programs with peers and family involvement could increase the practice of FP among rural Myanmar women.

Development of a rapid, simple method for detecting Naegleria fowleri visually in water samples by loop-mediated isothermal amplification (LAMP).

Naegleria fowleri is the causative agent of the fatal disease primary amebic meningoencephalitis. Detection of N. fowleri using conventional culture and biochemical-based assays is time-consuming and laborious, while molecular techniques, such as PCR, require laboratory skills and expensive equipment. We developed and evaluated a novel loop-mediated isothermal amplification (LAMP) assay targeting the virulence-related gene for N. fowleri. Time to results is about 90 min and amplification products were easily detected visually using hydroxy naphthol blue. The LAMP was highly specific after testing against related microorganisms and able to detect one trophozoite, as determined with spiked water and cerebrospinal fluid samples. The assay was then evaluated with a set of 80 water samples collected during the flooding crisis in Thailand in 2011, and 30 natural water samples from border areas of northern, eastern, western, and southern Thailand. N. fowleri was detected in 13 and 10 samples using LAMP and PCR, respectively, with a Kappa coefficient of 0.855. To the best of our knowledge, this is the first report of a LAMP assay for N. fowleri. Due to its simplicity, speed, and high sensitivity, the LAMP method described here might be useful for quickly detecting and diagnosing N. fowleri in water and clinical samples, particularly in resource-poor settings.

Quality of life among breast cancer patients undergoing treatment in national cancer centers in Nepal.

PURPOSE: To study the quality of life and to identify associated factors among breast cancer patients undergoing treatment in national cancer centers in Nepal. MATERIALS AND METHODS: One hundred breast cancer patients were selected and interviewed using a structured questionnaire. European Organization of Research and Treatment of Cancer EORTC-QLQ-C30 and EORTC-QLQ-BR23 were used to assess quality of life and modified Medical Outcome Study -Social Support survey(mMOS-SS) was used to assess social support. Only multi-item scales of EORTC C30 and BR23 were analyzed for relationships. Independent sample T-tests and ANOVA were applied to analyze differences in mean scores. RESULTS: The score of global health status/quality of life (GHS/GQoL) was marginally above average (mean=52.8). The worst performed scales in C-30 were emotional and social function while best performed scales were physical and role function. In BR-23, most of the patients fell into the problematic group regarding sexual function and enjoyment. Almost 90% had financial difficulties. Symptom scales did not demonstrate many problems. Older individuals, patients with stage I breast cancer and thosewith good social support were found to have good GHS/GQoL. Of all the influencing factors, social support was established to have strong statistical associations with most of the functional scales: GHS/GQoL (0.003), emotional function (<0.001), cognitive function (0.020), social function (<0.001) and body image function (0.011). Body image was significantly associated with most of the influencing factors: monthly family income (0.003), type of treatment (<0.001), type of surgery (<0.001), stage of cancer (0.017) and social support (0.011). CONCLUSIONS: Strategies to improve social support of the patients undergoing treatment should be given priority and financial difficulties faced by breast cancer patients should be well addressed from a policy making level by initiating health financing system.

Community participation of cross-border migrants for primary health care in Thailand.

This is the first report of the large-scale utilization of migrants as health volunteers in a migrant primary-healthcare program. The program recruited migrants who volunteered to serve their communities. This study explores the identities of these volunteers, their relationship with program management, and their attitudes. The study also investigates the impact of the volunteers, from the migrants' and healthcare workers' perspective. The study was conducted in two provinces, Tak (northern Thailand) and Samut Sakhon (central Thailand). Primary and secondary information was collected. Mixed methods, comprising in-depth interviews, observation and questionnaires, were used to gather primary data from three groups of participants-migrant volunteers, migrants and healthcare workers. Secondary data, and in-depth interviews with healthcare workers, showed that migrant volunteers made a significant contribution to the provision of both preventive and curative services. The quantitative study covered 260 migrant volunteers and 446 migrants. The results found that <5% of volunteers were selected by the community. Almost all attended a training course. Most were assigned to be health communicators; four stated they did nothing. Volunteers' attitudes were very positive. Most migrants reported that the volunteers' work was useful. It was concluded that the migrant health-volunteer program did help deal with migrant health problems. However, management of the program should be closely considered for more effective outcomes.

Serum cholinesterase levels of Thai chilli-farm workers exposed to chemical pesticides: prevalence estimates and associated factors.

OBJECTIVE: To estimate the prevalence of, and factors associated with, abnormal serum cholinesterase (SChE) levels among chilli-farm workers in Chatturat District, Chaiyaphum Province. METHODS: A total of 350 chilli-farm workers aged 18-60 yr were randomly sampled and interviewed. A reactive-paper finger-blood test was used to assess SChE levels. RESULTS: The prevalence of abnormal SChE levels was 32.0%. The most common pesticide-related symptoms were dizziness (38.0%), headache (30.9%), nausea/vomiting (26.9%), and fever (26.9%). Multiple logistic regression analysis revealed 7 factors were independently associated with abnormal SChE level: male gender, single/separated/divorced, being a permanent worker, spraying pesticide more than 3 times per month, having moderate or poor pesticide-use behaviors, and low perceived susceptibility and severity of pesticide use. CONCLUSIONS: The prevalence of abnormal SChE levels among chilli-farm workers was quite high. It would be beneficial to decrease pesticide use and encourage alternative measures. Effective preventive interventions to increase correct perceptions of pesticide use, the use of personal protective measures and continuing monitoring for blood cholinesterase, especially for male permanent farm workers, are recommended.