Establishment of a comprehensive surveillance system for acute pesticide poisoning in Tanzania

Doctoral Thesis


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University of Cape Town

Widespread under-reporting of acute pesticide poisoning (APP) in developing countries, such as Tanzania, leads to under-estimation of the burden from APP. This thesis aimed to characterize the health consequences of APP in rural agricultural areas in Tanzania with a view to developing an effective surveillance system for APP. Several sub-studies comprise this thesis: A household survey of farmers; A hospital data review for APP, both retrospective, covering a 6-year period, and prospective for 12 months;Health care providers' knowledge and practices relating to APP and notification;Pesticide retailers' knowledge, distribution and handling practices; Stakeholder views regarding APP, notification and risk reduction strategies; and an assessment of APP data from sources other than the hospital system. The study found that major agents responsible for poisoning included Organophosphates and highly or moderately hazardous products and the age group 20 - 30 years was most affected. The majority of health care providers lacked skills for diagnosis of APP. The most problematic circumstances of poisoning in hospital data review was suicide but was occupational with pesticide stakeholders and in household surveys. Prospective data collection in the hospital review reduced the amount of missing data, suggesting that with proper training and support, hospital-based reporting can provide better surveillance data. Many farmers and pesticide retailers had unsafe practices likely to result in exposure and risk for poisoning. Modelling suggested that the Incidence Rate for occupational poisoning ranged from 11.3 to 279.8 cases per million people with a medium estimate of 32.4 cases per million people. The study identified a high burden from APP in Tanzania, largely unreported, particularly from occupational poisonings, and proposes an APP surveillance system for Tanzania aimed at addressing both workplace and non-workplace settings. The system is expected to identify poisoning outbreaks, circumstances and outcomes, agents, poisoning patterns by gender, age, population and geographical areas most affected. Data sources for the system will include health care facilities and other government Institutions, media and community members through community self-monitoring. The system is expected to generate rate estimates and trends for pesticide poisoning, identify opportunities for prevention, further research needs and, ultimately, assist in reducing health risks arising from pesticide exposure.

Includes bibliographical references.