Abstract:The study aimed to assess the association of long-term pesticide exposure (≥5 years) with hematological, serum biochemical parameters and acetylcholinesterase activity in farm workers. These pesticides included organophosphorus pesticides, carbamates, pyrethroids, dithiocarbamates, and other pesticides such as endosulfan. Applying a cross-sectional study design, 69 females from a pesticide-exposed farm population and 30 females from a district not using pesticides (reference group) were studied. The mean red cell corpuscular volume and hematocrit values were significantly lower (74.7 ± 9.1 fl; 95% CI 72.5-76.9 and 32.0% ± 4.6%; 95% CI 30.9-33.1, respectively) in the exposed compared to the reference group, whereas mean corpuscular hemoglobin concentration and platelets were significantly higher (37.4 ± 3.8 g/dL; 95% CI 36.5-38.3 and 374.1 ± 95.3/L; 95% CI 351.2-396.9, respectively) in the exposed compared to the reference group. Mean serum glutamic oxaloacetate transaminase (20.7 ± 8.9 U/L; 95% CI 18.5-22.9) and creatinine (83.9 ± 6.6 µmol/L; 95% CI 82.3-85.5) were significantly higher in the exposed compared to the reference group. A higher mean esterase activity (AChE 0.6 ± 0.2 mM/min/mg protein; 95% CI 0.56-0.7; BChE 0.9 ± 0.4 mM/min/mg protein; 95% CI 0.9-1.1) was noted in the exposed group. Regression models suggest that occupational exposure (p < 0.001) could be a predictor of esterase (AChE and BChE) activity and biochemical changes (β = 0.4, 95% CI: 0.3-0.5; β = 0.7, 95% CI: 0.6-0.9, respectively). Long-term pesticide exposure affects the hemato-biochemical and esterase responses, establishing the need for further studies.