Economic burden of illness from pesticide poisonings in highland Ecuador

Abstract

Active surveillance of acute pesticide poisonings in a potato-growing region of highland Ecuador during 1991-1992 uncovered a rate of 171/100,000, due predominantly to occupational exposures to organophosphate and carbamate pesticides. Occupational exposure among agricultural workers was the most common reason for poisoning (32 male workers and 1 female worker, out of a total of 50 cases). Of these 33 cases, 28 of them reported pesticide application as the work task just prior to poisoning, with over 80% citing the use of World Health Organization Hazard Category I pesticides. The suicide rate of 17.1/100,000 and the overall mortality rate of 20.5/100,000 that we found are among the highest reported anywhere in the world. At the exchange rates prevailing at that time, median costs associated with these poisonings were estimated as follows: public and social security health care direct costs of US$ 9.85/case; private health costs of US$ 8.33/case; and lost-time indirect costs of US$ 8.33/agricultural worker. Each one of those costs was over five times the daily agricultural wage, which was then about US$ 1.50. Further costing of pesticide poisonings should be carried out in other settings to provide appropriate information for decisions about pesticide use. In addition, integrated pest management should be further evaluated as an appropriate technology to reduce the economic burden of illness from pesticide poisonings in developing countries.

Understanding the Full Costs of Pesticides: Experience from the Field, with a Focus on Africa

“…The work of Cole, Sherwood and colleagues in smallholder potato production in Ecuador is possibly the best and most detailed multidisciplinary study to analyse the costs of acute and chronic health impacts (Cole et al, 2000;Sherwood et al, 2005). Using a combination of questionnaire surveys, focus groups, bioassay, physical tests and household exposure sampling, their findings highlighted the 'invisible' face of chronic exposure to hazardous insecticides, from low-level but cumulative effects on the nervous system, motor coordination and behavioural function.…”

Suicide and exposure to organophosphate insecticides: Cause or effect?

“…For example, Cole et al [2000] found that only 16% of cases detected with intensified passive surveillance in a potato farming area of Ecuador in 1991/1992 were due to suicide. Surveys and mandatory reporting to the Health Ministry in Nicaragua consistently yielded a proportion of 6% or less of pesticide poisoning cases due to suicide across [Castillo-Martinez and de Vos, 1988Appel et al, 1991] and in Costa Rica of 10% or less in 1995.…”

“…London and Bailie [2001] found that intensification of passive surveillance uncovered under-reporting on the order of 80%, and that under-reporting selectively missed causes other than suicide (and cases among women). Similar attempts to intensify passive reporting in Ecuador showed far higher rates of work-related poisonings than suicides [Cole et al, 2000]. In addition, most studies cited in Table I in Asian and African populations are not based on reporting or surveillance systems but on ad hoc reviews of cases of hospitalized patients, which reflects the lack of established surveillance systems in many developing countries.…”

Resource concentration dilutes a key pest in indigenous potato agriculture

“…Insecticide applications are cheap, but their use to manage potato weevils has been implicated in acute poisonings among Andean farmers at rates matching the highest reported anywhere in the world (Crissman et al 1998, Cole et al 2000. On the other hand, IPM tactics are safe but labor intensive, relying largely on reducing the pool of overwintering weevils, which are thought to be widely dispersed over the landscape, before they can immigrate into potato fields (Ortiz et al 1996).…”