A call from 40 public health scientists for an end to the continuing humanitarian and environmental catastrophe in Gaza.

An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health. This commentary contextualises these impacts against the background of human suffering produced by the overwhelming violence associated with the use of military force against the general population of Gaza. In calling for an immediate cessation to the violence, the authors draw attention to the urgent need to rebuild the health care system and restore the physical and human infrastructure that makes a liveable environment possible and promotes human health and well-being, especially for the most vulnerable in the population. Environmental remediation should therefore form one of the most important parts of international efforts to assist reconstruction, through which we hope Palestinians and Israelis will achieve lasting peace, health, and sustainable development, all as part of accepted international human rights obligations.

The role of alcohol use in pesticide suicide and self-harm: a scoping review.

PURPOSE: Suicide and self-harm by pesticide self-poisoning is common in low- and middle-income countries (LMICs). Alcohol is an important risk factor for self-harm; however, little is known about its role in pesticide self-poisoning. This scoping review explores the role that alcohol plays in pesticide self-harm and suicide. METHODS: The review followed the Joanna Briggs Institute scoping review guidance. Searches were undertaken in 14 databases, Google Scholar, and relevant websites. Articles were included if they focussed on pesticide self-harm and/or suicide and involvement of alcohol. RESULTS: Following screening of 1281 articles, 52 were included. Almost half were case reports (n = 24) and 16 focussed on Sri Lanka. Just over half described the acute impact of alcohol (n = 286), followed by acute and chronic alcohol use (n = 9), chronic use, (n = 4,) and only two articles addressed harm to others. One systematic review/meta-analysis showed increased risk of intubation and death in patients with co-ingested alcohol and pesticides. Most individuals who consumed alcohol before self-harming with pesticides were men, but alcohol use among this group also led to pesticide self-harm among family members. Individual interventions were recognised as reducing or moderating alcohol use, but no study discussed population-level alcohol interventions as a strategy for pesticide suicide and self-harm prevention. CONCLUSION: Research on alcohol's role in pesticide self-harm and suicide is limited. Future studies are needed to: further assess the toxicological effects of combined alcohol and pesticide ingestion, explore harm to others from alcohol including pesticide self-harm, and to integrate efforts to prevent harmful alcohol use and self-harm.

Assessing HIV provider knowledge, screening practices, and training needs for HIV-associated neurocognitive disorders. A short report.

Management of HIV-associated neurocognitive disorders (HAND) is becoming increasingly important with HIV-positive people living normal life spans. We aimed to establish the level of HAND awareness among doctor and nurse occupational health practitioners, screening used to detect impairment, factors limiting screening for HAND, and training needs. One-hundred-and-five members of the nursing and physician professional societies for occupational health practitioners in South Africa and Occupational Health Departments at five South African universities responded to an email invitation to complete an online survey addressing demographics, HAND knowledge, screeners being used to screen for HAND and related training needs. While 80% had heard of HAND, few (13.3%) were aware of the Frascati criteria. Only 2% had received training addressing HAND; 11.4% screened for HAND; 45.7% did not know what screening tool to us; 80% preferred spending <15 min on screening. The largest obstacle to screening was lack of expertise (77.1%) but 77.3% thought it important to screen for HAND. 94.3% wanted screening training. Health providers are poorly informed about HAND and lack expertise and tools to screen for HAND in their treatment programs. While few had relevant training, they recognize the importance of screening for HAND in the workplace and desire training.

A call to advance and translate research into policy on governance, ethics, and conflicts of interest in public health: the GECI-PH network.

Efforts to adopt public health policies that would limit the consumption of unhealthy commodities, such as tobacco, alcohol and ultra-processed food products, are often undermined by private sector actors whose profits depend on the sales of such products. There is ample evidence showing that these corporations not only try to influence public health policy; they also shape research, practice and public opinion. Globalization, trade and investment agreements, and privatization, amongst other factors, have facilitated the growing influence of private sector actors on public health at both national and global levels. Protecting and promoting public health from the undue influence of private sector actors is thus an urgent task. With this backdrop in mind, we launched the "Governance, Ethics, and Conflicts of Interest in Public Health" Network (GECI-PH Network) in 2018. Our network seeks to share, collate, promote and foster knowledge on governance, ethical, and conflicts of interest that arise in the interactions between private sectors actors and those in public health, and within multi-stakeholder mechanisms where dividing lines between different actors are often blurred. We call for strong guidance to address and manage the influence of private sector actors on public health policy, research and practice, and for dialogue on this important topic. Our network recently reached 119 members. Membership is diverse in composition and expertise, location, and institutions. We invite colleagues with a common interest to join our network.

Case Report Detailing an Inferior Myocardial Infarction, Third-Degree Heart Block, and Cardiogenic Shock.

An infarction in the right coronary artery affects the inferior wall of the heart and can also cause impedance to the cardiac conduction system. The right coronary artery perfuses the sinoatrial and atrioventricular nodes, and a loss of blood flow contributes to a breakdown in the communication system within the heart, causing associated bradycardias, heart blocks, and arrhythmias. This case report details the prehospital and emergency care of a middle-aged man who experienced an inferior myocardial infarction, concomitant third-degree heart block, and subsequent cardiogenic shock, with successful revascularization. This case is informative for emergency clinicians to review symptoms of acute coronary syndrome, rapid lifesaving diagnostics and intervention, and the unique treatment and monitoring considerations associated with right ventricular involvement and third-degree heart block.

Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania.

BACKGROUND: Acute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production. METHODS: Over the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006. RESULTS: The study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20-29 years old who comprised 38.4% of all cases with suicide as circumstance. Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively. CONCLUSION: APP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.

Equity in household spending on alcoholic beverages in South Africa: assessing changes between 1995 and 2011.

BACKGROUND: Globally, alcohol consumption accounts for a substantial burden of disease, which translates into high social and economic costs. To address this burden, several policies (e.g. age and trading hour restrictions, increasing alcohol taxation) were implemented. Despite the existence of these policies evidence shows that alcohol misuse and alcohol-related harms have increased in South Africa over recent years. The objective of this paper is to assess progressivity and the changes in progressivity of alcohol expenditure at the household level in South Africa using datasets that span 15 years. METHODS: Data come from the 1995, 2000, 2005/06 and 2010/11 South Africa Income Expenditure Survey. Distribution of spending on alcoholic beverages were analyzed using standard methodologies. Changes in progressivity between 1995 and 2000, and between 2005/06 and 2010/11 were also assessed using the Kakwani index. RESULTS: Alcohol spending was regressive between 1995 and 2011 as the fraction of poorer households' expenditure spent on alcohol beverage exceeds that for the richest households. Also, the difference in Kakwani indexes of progressivity indicates that spending on alcoholic beverages has become less regressive between the same time periods. CONCLUSION: The results show no evidence that alcohol policy including taxation increased regressivity. Thus, there is an opportunity to further reduce the regressivity using coherent alcohol policies. This paper concludes that there is a need for further research to unpack why alcohol spending became less regressive over the years that goes beyond just looking at changes in the distribution of alcohol expenditure.

The health impacts of extractive industry transnational corporations: a study of Rio Tinto in Australia and Southern Africa.

BACKGROUND: Operations of transnational corporations (TNCs) affect population health through production methods, shaping social determinants of health, or by influencing regulation of their activities. Research on community exposures to TNC practices and policies has been limited. Our research on extractive industries examined Rio Tinto in Australia and Southern Africa to test methods for assessing the health impacts of corporates in high and middle income jurisdictions with different regulatory frameworks. METHODS: We adapted existing Health Impact Assessment methods. Data identifying potential impacts were sourced through media analysis, document analysis, company literature and semi-structured interviews. The data were mapped against a corporate health impact assessment framework (CHIA) which included Rio Tinto's political and business practices; productions; and workforce, social, environmental and economic conditions. RESULTS: Both positive and detrimental aspects of Rio Tinto's operations were identified. Requirements imposed by Rio Tinto on its global supply chain are likely to have positive health impacts for workers. However, political lobbying and membership of representative organisations can influence government policy in ways that are unfavourable to health and equity. Positive impacts include provision of direct employment under decent working conditions, but countered by an increase in precariousness of employment. Commitments to upholding sustainable development principles are undermined by limited site remediation and other environmental impacts. Positive contributions are made to national and local economies but then undermined by business strategies that include tax minimisation. CONCLUSION: Our study confirmed that it is possible to undertake a CHIA on an extractive industry TNC. The different methods provided sufficient information to understand the need to strengthen regulations that are conducive to health; the opportunity for Rio Tinto to extend corporate responsibility initiatives and support their social licence to operate; and for civil society actors to inform their advocacy towards improving health and equity outcomes from TNC operations.

Access to palliative care in HIV services in Cape Town.

This paper examines access to palliative care (PC) for patients with HIV, part of a study investigating access to PC for patients with chronic diseases. Studies highlight gaps in symptom management and psychosocial care for People living with HIV (PLHIV) and thus the need to integrate PC into HIV services. The aim of the study was to describe the access of patients with advanced chronic illness to PC services. METHODOLOGY: this was a prospective cohort study conducted over six months. Participants were recruited from patients living with HIV with CD4 counts of <200 cells/mm3, patients with advanced cancer and patients diagnosed with motor neurone disease. All HIV patients were on anti-retroviral treatment. Participants responded to a questionnaire including the APCA African Palliative Outcome Scale (POS), a validated palliative outcome scale, as a measure of care at first visit and telephonically once a month for 6 months. RESULTS: Seventy-nine HIV patients were recruited to the study. During the study 6 PLHIV died and no HIV patients were referred to PC services. A significant finding is that most patient outcomes improved for HIV patients. Pain reduced from 1.83 to 0.86; symptoms reduced from 2.41 to 0.49; worry reduced from 2.17 to 0.35. Spiritual well-being also improved - life worthwhile from 3.56 to 4.74 and at peace from 3.63 to 4.86; all measures out of 5. A small sub-set of this cohort (7.7%) experienced high pain levels not controlled during the study. DISCUSSION: Few patients were referred to PC services despite 6 HIV deaths during the study. Patients attending HIV clinics received good PC in conjunction with HAART, suggesting that PC appears to be well integrated into routine HIV care. It is suggested that patients with severe problems including those who died would have benefitted from referral to PC.

Occupational health: a world of false promises.

The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy decisions, ensure greater freedom to operate without interference.

Missing knowledge of gendered power relations among non-governmental organisations doing right to health work: a case study from South Africa.

BACKGROUND: Despite 20 years of democracy, South Africa still suffers from profound health inequalities. Gender roles and norms are associated with individuals' vulnerability that lead to ill-health. For instance, gender inequality influences women's access to health care and women's agency to make health-related decisions. This paper explores gender-awareness and inclusivity in organisations that advocate for the right to health in South Africa, and analyses how this knowledge impacts their work? METHODS: In total, 10 in-depth interviews were conducted with members of The Learning Network for Health and Human Rights (LN), a network of universities and Civil Society Organisations (CSOs) which is explicitly committed to advancing the right to health, but not explicitly gendered in its orientation. RESULTS: The results show that there is a discrepancy in knowledge around gender and gendered power relations between LN members. This discrepancy in understanding gendered power relations suggests that gender is 'rendered invisible' within the LN, which impacts the way the LN advocates for the right to health. CONCLUSIONS: Even organizations that work on health rights of women might be unaware of the possibility of gender invisibility within their organisational structures.

DNA variants and organophosphate neurotoxicity among emerging farmers in the Western Cape of South Africa.

BACKGROUND: Previous epidemiological studies investigating modification of organophosphate (OP) neurotoxicity by xenobiotic metabolizing enzymes (XMEs) polymorphisms have produced inconsistent results. METHODS: A cross-sectional study of 301 emerging farmers was conducted. Neurotoxicity testing included forward and backward recall, digit span, and vibration sensitivity testing. Questionnaire data included demography, potential confounders, and work history of pesticide exposures. Genomic DNA was analyzed from study participants for DNA variants of two glutathione S-transferases (GSTM1 and GSTT1), N-acetyltransferase 2 (NAT2), and Paraoxonase 1 (PON1). RESULTS: There was evidence of OP pesticide neurotoxicity modification by rs1799931 (NAT2), rs662 (PON1), and the null allele of GSTM1 in multivariate analysis. The strongest evidence of modification was observed for rs1799931 (NAT2) on the relationship between pesticide poisoning and impaired vibration sense. CONCLUSIONS: DNA variants of NAT2, PON1, and GSTM1 may modify OP neurotoxicity, and this requires further exploration.

A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa.

BACKGROUND: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town. METHODS: Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted. RESULTS: Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital. DISCUSSION: The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers. CONCLUSIONS: Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

Undereporting of acute pesticide poisoning in Tanzania: modelling results from two cross-sectional studies.

BACKGROUND: Acute pesticide poisoning (APP) is known to cause serious injuries to end users globally but the magnitude of this problem in Tanzania is not well known. This study aimed to determine the extent and pattern of underreporting of APP in Tanzania to inform the development of a surveillance system and appropriate interventions. METHODS: This study integrates findings from two recent Tanzanian studies. A household survey established the proportion of poisoned farmers in a typical rural area who reported to hospital for a pesticide poisoning. Only 5 of the 112 farmers who reported attending hospital due to poisonings could be traced in medical records at the facilities they claimed to have attended. The 95% confidence interval for this ratio (5/112) was used to generate a high and low boundary for the estimates. Three under-estimation factors were generated for sensitivity analysis to adjust for under-reporting. A review of health facilities in three regions of Tanzania collected prospective data on admissions for APP in 2006 to generate population-based APP incidence rates stratified by circumstances of poisoning (occupational, accidental, suicide, and unknown). Sensitivity analysis was conducted involving adjustment for high and low boundaries of the under-reporting of occupational APP and an adjustment for different scenario allocations of cases with 'unknown' circumstances to different combinations of known circumstances. RESULTS: The study estimated the rate of occupational poisoning as ranging from 11.3-37.7 cases/million to 84.3-279.9 cases per million. The rate of all poisonings (occupational and non-occupational) ranged from 24.45-48.01 cases per million to 97.37-290.29 cases per million. Depending on the choice of scenario and under-reporting correction factor used, occupational APP could comprise from 52.2 to 96% of all APP cases. CONCLUSION: The study confirms that data on APP in Tanzanian hospitals are poorly reported and that occupational circumstances are particularly overlooked in routine facility-based surveillance. Occupational APP needs to be taken more seriously in addressing prevention measures. A comprehensive surveillance system for APP should consider multiple data sources including community self-reporting in order to achieve better coverage.

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey.

BACKGROUND: Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa. METHODS: Data from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents' last pregnancy. RESULTS: Overall prevalence among urban women of early ANC initiation was 46% and 84% for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45% and 78% for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95% CI 1.0-2.5) and wanted pregnancy (OR 1.8; 95% CI 1.1-3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95% CI 1.0-3.6) but inversely associated with high religiosity (OR 0.5; 95% CI 0.3-0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95% CI 1.9-9.3) and the father of the child being present in the respondent's life (OR 3.0; 95% CI 1.0-9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95% CI 0.2-0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site. CONCLUSION: The majority of women from both sites attended ANC frequently but less than 50% initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women's reproductive health.

Assessing the health impact of transnational corporations: its importance and a framework.

BACKGROUND: The adverse health and equity impacts of transnational corporations' (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and thus to inform actions to mitigate or reverse negative and increase positive impacts. METHODS: This paper reports on a framework designed to conduct corporate health impact assessment (CHIA), developed at a meeting held at the Rockefeller Foundation Bellagio Center in May 2015. RESULTS: On the basis of the deliberations at the meeting it was recommended that the CHIA should be based on ex post assessment and follow the standard HIA steps of screening, scoping, identification, assessment, decision-making and recommendations. A framework to conduct the CHIA was developed and designed to be applied to a TNC's practices internationally, and within countries to enable comparison of practices and health impacts in different settings. The meeting participants proposed that impacts should be assessed according to the TNC's global and national operating context; its organisational structure, political and business practices (including the type, distribution and marketing of its products); and workforce and working conditions, social factors, the environment, consumption patterns, and economic conditions within countries. CONCLUSION: We anticipate that the results of the CHIA will be used by civil society for capacity building and advocacy purposes, by governments to inform regulatory decision-making, and by TNCs to lessen their negative health impacts on health and fulfil commitments made to corporate social responsibility.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

BACKGROUND: Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT: The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION: SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

Pesticide retailers' knowledge and handling practices in selected towns of Tanzania.

BACKGROUND: Approximately 300 pesticide retailers are currently registered in Tanzania. Inadequate knowledge and unsafe handling practices among retailers may contribute to human pesticide exposure and environmental contamination. This study investigated pesticide retailers' qualifications, work experience, safety practices and the products distributed so as to identify opportunities for preventing Acute Pesticide Poisoning (APP). METHODOLOGY: In 2005, employees of pesticide retail firms in six Tanzanian towns were surveyed using a semi-structured questionnaire and physical inspection of premises. In addition, information on products distributed in 2004 and 2005 was collected from Arusha and Arumeru firms to assess potential risk posed for end-users. RESULTS: More than half of the participating firms (58.6%) were not registered. Most agents on sale in Arusha and Arumeru were hazardous products including WHO Class I and II products (61.7%) and the mean number of cholinesterase inhibiting agents was 5.8 (range 2-8). Major deficiencies found included semi-trained staff (52%), lack of first-aid kits (38.6%), repacking and decanting of pesticides into smaller unlabelled containers (25.3%), lack of fire-fighting equipment (22.6%) and distribution of unregistered products (9.3%). Compared to unregistered companies, those companies that were registered were more likely to report practicing safe container disposal (40% versus 19%; p = 0.06) and to have an absence of leaking containers (36% versus 15%; p = 0.04). CONCLUSION: Pesticide distribution in Tanzania was accompanied by many unsafe practices that may contribute to the burden from APP, not only affecting the distributors but also farmers who buy and use these products. Market pressures appear to be encouraging decanting of pesticides to enable retailers to make profits. Registration of firms appears to be associated with safer practices. Comprehensive interventions to strengthen enforcement mechanisms by increasing the number of pesticide inspectors, ensuring adequate financial support for enforcement activities and providing training opportunities for pesticide retailers and the end users are strongly recommended.

Farmers' knowledge, practices and injuries associated with pesticide exposure in rural farming villages in Tanzania.

BACKGROUND: Pesticides in Tanzania are extensively used for pest control in agriculture. Their usage and unsafe handling practices may potentially result in high farmer exposures and adverse health effects.The aim of this study was to describe farmers' pesticide exposure profile, knowledge about pesticide hazards, experience of previous poisoning, hazardous practices that may lead to Acute Pesticide Poisoning (APP) and the extent to which APP is reported. METHODS: The study involved 121 head- of-household respondents from Arumeru district in Arusha region. Data collection involved administration of a standardised questionnaire to farmers and documentation of storage practices. Unsafe pesticide handling practices were assessed through observation of pesticide storage, conditions of personal protective equipment (PPE) and through self-reports of pesticide disposal and equipment calibration. RESULTS: Past lifetime pesticide poisoning was reported by 93% of farmers. The agents reported as responsible for poisoning were Organophosphates (42%) and WHO Class II agents (77.6%).Storage of pesticides in the home was reported by 79% of farmers. Respondents with higher education levels were significantly less likely to store pesticides in their home (PRR High/Low = 0.3; 95% CI = 0.1-0.7) and more likely to practice calibration of spray equipment (PRR High/Low = 1.2; 95% CI = 1.03-1.4). However, knowledge of routes of exposure was not associated with safety practices particularly for disposal, equipment wash area, storage and use of PPE . The majority of farmers experiencing APP in the past (79%) did not attend hospital and of the 23 farmers who did so in the preceding year, records could be traced for only 22% of these cases. CONCLUSIONS: The study found a high potential for pesticide exposure in the selected community in rural Tanzania, a high frequency of self-reported APP and poor recording in hospital records. Farmers' knowledge levels appeared to be unrelated to their risk. Rather than simply focusing on knowledge-based strategies, comprehensive interventions are needed to reduce both exposure and health risks, including training, improvements in labeling, measures to reduce cost barriers to the adoption of safe behaviours, , promotion of control measures other than PPE and support for Integrated Pest Management (IPM).