Factors Associated With Practice of Chemical Pesticide Use and Acute Poisoning Experienced by Farmers in Chitwan District, Nepal

Abstract

Background: Irrational use and unsafe handling of pesticides in agriculture farming is a serious public health concern in developing countries including Nepal. This study was conducted to assess the practice of chemical pesticide use and associated factors along with the acute health symptoms experienced by farmers in Chitwan District, Nepal.
Methods: This was a descriptive cross-sectional study using quantitative methods with 790 farmers from Chitwan district, Nepal selected through systematic random sampling. Scores for knowledge, attitude/perception and practice were calculated by aggregating variables where each variable was scored 1 or 0 based on a right or wrong answer. Further, the practice variable was segregated into three groups namely practice during purchasing, practice during mixing and spraying and practice during storage and disposal. Statistical analysis was performed with X2 test, T-test and Multiple Logistic Regression. Confounder controls were made for age, sex and education.
Results: Out of the 790 farmers, 663 (84.0%) were found to use exclusively chemical pesticide. Among them, 62% had no idea about its label. Farmers with better knowledge on pesticide handling were 8.3 times more likely to practice safe purchasing (95% CI=5.0-13.8), four times more likely to practice safe mixing and spraying (95% CI=2.5-5.9) and two times more likely to safe storage and disposal (95% CI=1.6-3.6). Similarly, perception/attitude of farmers about chemical pesticide policy and market management was significantly associated with the practice of farmers during purchasing (95% CI=1.1-2.8), mixing and spraying (95% CI=2.0-4.5) and storage and disposal (95% CI=1.1-2.5). Farmers with unsafe practice of pesticide handling were two times more likely to suffer from acute poisoning (AOR = 2.1, 95% CI = 1.3-3.3).
Conclusion: There was a high use of pesticide in agriculture farming in Chitwan District. Improving knowledge of farmers on safe handling of pesticides and developing strategies for proper market management would promote the safe handling practices among farmers and reduce the acute pesticide poisoning in Nepal.

Full text

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Factors Associated With Practice of Chemical
Pesticide Use and Acute Poisoning Experienced by
Farmers in Chitwan District, Nepal
SIMRIN KAFLE (  simrinkae@gmail.com )
Nepal Public Health Foundation https://orcid.org/0000-0001-7453-4118
Abhinav Vaidya
Public Health Foundation
Bandana Pradhan
Tribhuvan University Institute of Medicine
Erik Jørs
Odense University Hospital: Odense Universitetshospital
Sharad Onta
Nepal Public Health Foundation
Research
Keywords: Pesticides, Safety measures, Acute poisoning, Nepal
DOI: https://doi.org/10.21203/rs.3.rs-93874/v1
License:   This work is licensed under a Creative Commons Attribution 4.0 International License. 
Read Full License

Page 2/19
Abstract
Background: Irrational use and unsafe handling of pesticides in agriculture farming is a serious public
health concern in developing countries including Nepal. This study was conducted to assess the practice
of chemical pesticide use and associated factors along with the acute health symptoms experienced by
farmers in Chitwan District, Nepal.
Methods: This was a descriptive cross-sectional study using quantitative methods with 790 farmers from
Chitwan district, Nepal selected through systematic random sampling. Scores for knowledge,
attitude/perception and practice were calculated by aggregating variables where each variable was
scored 1 or 0 based on a right or wrong answer. Further, the practice variable was segregated into three
groups namely practice during purchasing, practice during mixing and spraying and practice during
storage and disposal. Statistical analysis was performed with X2 test, T-test and Multiple Logistic
Regression. Confounder controls were made for age, sex and education.
Results: Out of the 790 farmers, 663 (84.0%) were found to use exclusively chemical pesticide. Among
them, 62% had no idea about its label. Farmers with better knowledge on pesticide handling were 8.3
times more likely to practice safe purchasing (95% CI=5.0-13.8), four times more likely to practice safe
mixing and spraying (95% CI=2.5-5.9) and two times more likely to safe storage and disposal (95% CI=1.6-
3.6). Similarly, perception/attitude of farmers about chemical pesticide policy and market management
was signicantly associated with the practice of farmers during purchasing (95% CI=1.1-2.8), mixing and
spraying (95% CI=2.0-4.5) and storage and disposal (95% CI=1.1-2.5). Farmers with unsafe practice of
pesticide handling were two times more likely to suffer from acute poisoning (AOR = 2.1, 95% CI = 1.3-
3.3).
Conclusion: There was a high use of pesticide in agriculture farming in Chitwan District. Improving
knowledge of farmers on safe handling of pesticides and developing strategies for proper market
management would promote the safe handling practices among farmers and reduce the acute pesticide
poisoning in Nepal.
Background
Increasing pesticide use in farming has become a global public health issue, affecting middle- and low-
income countries [1]. Global pesticide use increased by 46% between 1996 and 2016 [2, 3]. The total world
land area is 13.5 billion ha, of which 4.9 billion ha is agricultural land (37% of the total area) [4]. In 2016
the total amount of active ingredients in pesticides used in agriculture was 4.1 million tons worldwide [4].
In Nepal, the consumption average weight of active ingredients of pesticides applied per hectare is 396
g/ha [5]. This amount of consumption is lower in comparison to other countries (for example, India 0.5
kg/ha, China 14 kg/ha) [6], but due to irrational use and unsafe handling, the issue of pesticide use in
agriculture farming is becoming a growing public health concern [7, 8]. Moreover, its use in Nepal is

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concentrated in relatively few provinces and also increasing by about 20% per year [5]. Of the total
pesticides imported in the country, more than 90% is used in vegetable farming [5].
The Joint FAO/WHO meeting on pesticide residues has established Maximum Residual Limits (MRLs) for
pesticides in foods to ensure pesticide exposure through eating food over the lifetime will not lead to
adverse effects on health [9]. But, evidence suggests that many developing countries lack a pesticide
residue measurement system in place to effectively monitor the permissible limits of pesticides in foods
before entering into the market [3, 10], thus jeopardizing the health of the public.
Health problems associated with pesticide include poisonings due to suicide attempt, contaminated food,
unintended and occupational accidents and injuries leading to deaths [11]. Pesticide use is also linked to
several acute and chronic health problems, more noticeable in developing countries including Nepal [12-
14]. In Nepal, the issue of pesticide and its effect on human health has been stipulated in National Health
Policy 2020 for the rst time (policy number 6.12, strategy 6.12.5) stating that the state will control and
regulate the use of pesticides in foods affecting human health [15]. However, public health programs to
materialize this policy are yet to be designed and implemented [16].
Farmers are the ones who are most likely to be exposed to pesticides [17, 18] and, despite the increasing
import and use of pesticide in the country, studies about the practice of farmers on the issue and their
experience of health problems while handling them are still scanty [19]. In view of this, the present study
was conducted with the objective to assess knowledge, attitude/perception and practice (KAP) of farmers
and their experience of poisoning symptoms after exposure to pesticides with the aim to generate
evidence to reduce the harm associated with pesticide use.
Methods
Setting, study design and site
The descriptive cross-sectional study was conducted in Chitwan district, one of the 77 districts of Nepal,
and covered all of its seven municipalities. Located at south central part of the country in Bagmati
Province, the district is well known for high production of commercial vegetables coupled with easy
availability of chemical pesticides, legally or illegally imported through the porous borders [11]. The
duration of the study was from October 2019 to May 2020. The climate of Chitwan is hot and humid
tropical climate.
Study population and sampling
Farmers engaged in crop production were included in the study. The sampling frame for farmer selection
was obtained from District Cooperative Oce (DCO), Chitwan. Farmers engaged in agriculture
cooperatives registered in DCO provided the sampling frame.
For farmers, sample size was estimated using the formula and calculation as given, n=NZ2PQ/e 2 (N-1)
+Z2PQ [20], where, N represents the total number of crop growing farmers in Chitwan which was 42548,

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z= percentiles of the standard normal distribution corresponding to 95% condence level which is equal to
1.96, P= Percent of farmers using pesticides in their farm, was assumed 50. Therefore using the formula,
n = 42548(1.96) 2 *50*50/ (5) 2 (42548-1) + (1.96) 2 *50*50 = 379.78 and adding design effect = 380*2 =
760, and assuming non-response rate as 5%, the total sample size estimated for the study was 790.
For the sample selection, each municipality was considered as a cluster. There are one metropolitan city,
ve urban municipalities and one rural municipality in Chitwan district. Farmers' population in different
municipalities was rst identied and then we applied probability proportional to size sampling to
calculate sample size for each cluster from the total 790. Having listed the names of all farmers in an
excel sheet, we used systematic random sampling.
Data collection and tools
Data collection tools were developed reviewing relevant literature from the subject area being based on
indicators considered through literature [18, 21, 22] to assess the practice of farmers about safe handling
and associated factors. All the questions were close ended, developed in Nepali and translated into
English and then back translated into Nepali in order to check for its reliability. Interviewers were provided
three days training on objectives, methods and process of data collection and it was accomplished under
the supervision of the principal investigator. The tools were pre-tested in 10% of total sample size in the
adjoining district and any changes required were made. Face to face interview was conducted to collect
data from farmers. In addition, observation was done to their storehouse/place to verify their practice
during storage. Also the verbal expression about the label of pesticide used was veried through
observation of its container.
Study variables and scoring
Variables on the knowledge level of farmers were collected and scored 0 or 1. They were then aggregated
into an overall ‘knowledge variable’ and this aggregated variable on knowledge was classied asadequate
(13-17 score) or inadequate (0-12 score) (see Additional le 1)
Likewise, the attitude and perception of farmers about pesticide policy and market management had 14
variables with total 24 scores where 1-3 scores were given to each variable based on the perceived relative
weightage by the researcher team. Based on the median value, farmers were then considered as having
favorable (17-24 score) or unfavorable (0-16 score) perception (see Additional le 2).
The practice was scored based on 17 variables, segregated into 3 domains: practice during purchasing
(four variables), practice during mixing (four variables) and spraying and practice during storage and
disposal (nine variables) (Table 3). Each variable scored 1 if the practice conformed to safety
requirements or 0 if it did not (Annex I). Scores in each domain were aggregated, and taking the reference
of its median value, categorized into safe (≥ median) and unsafe (<median) practices.
Possible confounders such as sex, age, caste/ethnicity and education were collected.

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Data analysis
Data was entered into CSPro 7.3 software and analyzed using IBM SPSS 25. Descriptive statistics were
generated and proportions were compared using Pearson's Chi Square Test. Multinomial Logistic
Regression was then used to assess the association among different variables and to calculate adjusted
OR. Statistical signicance was determined at p<0.05.
Results
Socio-demographic characteristics of farmers
Out of the 790 farmers, the mean age of farmers was 46.04. More than half of farmers (53.7%) belonged
to the age group of 30-50 years, 85 below 30 and 281 above 50. Female farmers comprise 51%. Most of
them were from
Brahmin
and
Chettri
ethnicities, followed by indigenous communities
(Tharu, Magar,
Tamang, Newar and Chepang).
More than three-fourths of farmers (68.1%) were able to read and write
and most had attended some levels of formal education.
Use of pesticide by the farmers
Among the farmers participating in the study, 663 (84.0%) exclusively used chemical pesticide while 28
farmers (3.5%) used botanical bio-pesticides only. The rest (12.5%) used both botanical and chemical
pesticides in agriculture farming. The farmers exclusively using chemical pesticides (n=663) were
included in further analysis of practice. However, the knowledge and attitude/perception related questions
were answered by 790 farmers.
Among the 663 farmers who exclusively used chemical pesticides, 62% had no idea about the meaning of
the color of the label on the pesticide container. Among the remaining 252 farmers, slightly more than
one-fth (20.7%) used yellow labeled pesticides which are of second hazardous category. Two percent
farmers used banned pesticides indicated by red labels (most hazardous).
Among the 663 farmers using chemical pesticide, 60.8% had been using it for more than a decade.
Further, most (96%) farmers took advice from a nearby agro-vet (pesticide retailers) on matters related to
pest problems and the choice and use of pesticide.
Knowledge of farmers about safe handling of chemical pesticides
More than 90 percent farmers had knowledge about the importance to store pesticide away from the
reach of children and animals and about safety clothes while spraying pesticide (Table 1). Knowledge to
check the manufacture and expiry date of pesticide was found to be high (84.9%), while checking for the
label and information about waiting period before harvest during purchase were low(30% and 32%
respectively). Similarly, only a small proportion of farmers knew the procedure of triple rinsing to clean the
pesticide container after the spray (14.4%).

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Table 1: Knowledge of chemical pesticide use of farmers in the domains of purchase, mixing and
spraying, and storage and disposal (n=790)
Descriptions Number Percent
During purchase  
Check manufacture and expiry date 670 84.9
Check whether the bottle is sealed 615 77.9
Observe the labels of pesticide 239 30.3
Check the indication about waiting period 252 31.9
During mixing and spray  
Mix pesticide considering the dose indicated 366 46.4
Mix pesticide away from water sources 578 73.3
Check the container if it is leaking 483 61.2
Wear protective clothes while spray 736 93.2
Spray considering the wind blowing direction 621 78.7
Spray at the right time of the day (evening and in the morning after the dew is
dried out) 562 71.2
Maintain at least 1 meter distance between nozzle to body 421 53.4
Spray at the right stage of the crop development 380 48.2
Take caution not to eat, drink, or smoke during spray 677 85.8
During storage and disposal  
Store in a dry place 542 68.6
Store pesticide in a separate place away from children and animals 744 94.3
Wash spray tank after use with triple rinsing method 114 14.4
Dispose container safely with the consideration of the environment (bury in an
unused area) 396 50.1
Attitude and Perception of farmers about the role of government, consumers and farmers to reduce the
use of chemical pesticides
Eighty percent of the farmers believed that the government could discourage the irrational use of
chemical pesticides by providing subsidies to farmers adopting organic farming and IPM, and
establishing separate market and price set up for IPM and organic products (Table 4). Addressing the
issue of pesticide through policy guidelines was pointed out by 37 percent farmers. Nearly three-fourth of

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the farmers perceived consumers should be more cautious towards their health and 18 percent said
consumers should also inquire about pesticide use in foods they buy from the market. More than 85
percent farmers thought they also have the responsibility to promote organic products through their
willingness and innovativeness to practice alternative approaches to chemical pesticides in agriculture
farming.
Table 2: Attitude and Perception of farmers about chemical pesticide policy and market management
(n=790)
Description Number Percent
Role of the government
Provide subsidy for promoting organic/IPM farmers 636 80.5
Regular supervision and monitoring of pesticide use 499 63.2
Check open border for unregistered and hazardous pesticides 400 50.6
Establish pesticide residue measurement laboratory 324 41.0
Control import and promote local farmers products 413 52.3
Establish separate market and x a price for IPM/organic products 629 79.6
Conduct consumer awareness programs 610 77.2
Develop policy guidelines for market management 291 36.8
Role of consumers
Show concern about pesticide use in vegetable market 138 17.5
Prefer organic product 397 50.3
Select vegetable based on season, color and size 313 39.6
Be conscious about health effect of pesticides 559 70.8
Role of farmers
Have willingness to practice organic farming 700 88.6
Search for alternative to chemical pesticides 686 86.8
Practice of chemical pesticide use
Practice of chemical pesticide use by farmers was organized into 3 domains; practice during purchase,
practice during mixing and spray, and practice of storage and disposal of chemical pesticides.
Three-fourths of the farmers reported that they checked manufacture and expiry date while less than one-
fourths observed the label of pesticide during purchase (Table 5). Fifty four percent of the farmers used

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protective equipment during spray. Most of the farmers safely stored the chemical pesticides away from
the reach of children and animals, but less than thirty percent of farmers considered safety and
environment during disposal of pesticides.
Table 3: Practice of chemical pesticide use by farmers (n=663)
Descriptions Number Percent
During purchase  
Check the manufacture and expiry date 489 73.8
Check whether the bottle is sealed 436 65.8
Observe the labels of pesticide 153 23.1
Check the indication about waiting period 112 16.9
During mixing and spray  
Mix pesticide considering the dose indicated 229 34.5
Mix pesticide away from water sources 448 67.6
Check the container if it is leaking 281 42.4
Wear protective clothes from head to toe while spray 359 54.1
Spray considering the wind blowing direction 374 56.4
Spray at the right time of the day (evening and in the morning after the dew is
dried out) 241 36.3
Maintain at least 1 meter far from nozzle to body 189 28.5
Spray at the right stage of the crop development (not during owering stage) 161 24.3
Take caution not to eat, drink, or smoke during spray 309 46.6
During storage and disposal  
Store in a dry place 497 75.0
Store pesticide in a separate place (away from children and animals) 601 90.6
Wash the spray tank after use with triple rinsing method 346 52.2
Dispose the container safely with the consideration of the environment (bury in
an unused area) 194 29.3
Note: The gures in the table indicate number and percentage of farmers who practiced the safety
measures.

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Scores on knowledge, attitude/perception and practice of farmers about chemical pesticide use and its
safe handling
The knowledge, attitude/perception and the total practice scores were dichotomized into median and
above or below the median as adequate/inadequate knowledge, favorable/unfavorable
attitude/perception, and safe/unsafe practice, respectively. Accordingly, forty percent of farmers had
adequate knowledge about the safe handling of pesticide, and a similar proportion also practiced safe
handling. A similar proportion of farmers had favorable perception towards the role of local government,
consumers and themselves to reduce the use of pesticide (Figure 1).
Association of safe practice of chemical pesticides with farmers’ knowledge, attitude/perception and
socio-demographic factors
Out of the six variables studied, positive association with the practice of farmers on safe handling of
pesticides was observed with knowledge about safe practice and perception of farmers about market
management, gender and education, (Table 4). Farmers who had adequate knowledge were 8.3 times
more likely to practice safe purchasing, four times more likely to practice safe mixing and spraying, and
two times more likely to safely store and dispose. Similarly, perception of farmers about chemical
pesticide policy and market management was signicantly associated with the practice of farmers. There
was no signicant association between age of farmers and their caste/ethnicity with their practice of
adoption of safety measures while handling pesticide, so these variables were not included in the nal
analysis presented in table 4.
Table 4: Association offarmers’ pesticide handling practice with their knowledge and attitude/perception
(n=663)

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
Descriptions
During
Purchase
During
Mixing and spray
During
Storage and disposal
Safe
Practice
n (%)
COR
(95%
CI)
AOR
(95%
CI)
Safe
Practice
n (%)
COR
(95%
CI)
AOR
(95%
CI)
Safe
Practice
n (%)
COR
(95%
CI)
AOR
(95%
CI)
Knowledge of farmers about safe handling of pesticides
Adequate 141
(52.4) 11.2
(7.4-
17.2)*
8.3
(5.0-
13.8)*
176
(65.4) 6.6
(4.7-
9.4)*
3.9
(2.5-
5.9)*
177
(65.8) 3.5
(2.5-
4.9)*
2.4
(1.6-
3.6)*
Inadequate 35 (8.9) 1 1 87
(22.1) 1 1 138
(35.0) 1 1
Perception of farmers about chemical pesticide policy and market management
Favorable 123
(44.7) 5.1
(3.5-
7.4)*
1.7
(1.1-
2.8)*
175
(63.6) 5.9
(4.2-
8.3)*
3.0
(2.0-
4.5)*
173
(62.9) 2.9
(2.1-
4.0)*
1.7
(1.1-
2.5)*
Unfavorable 53
(13.7) 1 1 88
(22.7) 1 1 142
(36.6) 1 1
Gender
Male 114
(34.7) 2.3
(1.6-
3.3)*
2.0
(1.3-
3.1)*
176
(53.5) 3.2
(2.3-
4.5)*
3.3
(2.2-
4.8)*
172
(52.3) 1.4
(1.0-
1.9)*
1.2
(0.8-
1.7)*
Female 62
(18.6) 1 1 87
(26.0) 1 1 143
(42.8) 1 1
Education
Can read
and write
(literate)
160
(36.2) 7.2
(4.2-
12.5)*
6.8
(3.8-
12.3)*
203
(45.9) 2.2
(1.6-
3.2)*
1.7
(1.1-
2.6)*
241
(54.5) 2.3
(1.7-
3.3)*
2.0
(1.4-
2.9)*
Can't read
and write/
only name
16 (7.2) 1 1 60
(27.1) 1 1 74
(33.5) 1 1
*p<0.05; COR: Crude odds ratio; AOR: Adjusted odds ratio
Health problems experienced by farmers (n=663)
Nearly, one-fth of farmers (18.7%, n=124) had experienced one or more acute symptoms of health
problems after handling pesticides during the previous 12 months, which they related to the use of
chemical pesticides. Among them, dizziness and headache (n=74), skin allergies (n=66) and burning of
eyes (n=35) were the most common symptoms. Others reported nausea/vomiting (n=34), blurred vision,
and swelling of body and muscle cramps (n=20) (Figure 2). Farmers with unsafe practice of pesticide

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handling were two times more likely to suffer from acute poisoning (AOR = 2.1, 95% CI = 1.3-3.3) (Table
5). Most (89.5%) of them perceived these symptoms as normal or usual phenomena while handling
pesticides, and therefore, ignored health facility visits.
Table 5: Association ofacute health symptoms with safe handling practice (n=663)

Descriptions
Acute health symptoms
Yes
n (%)
COR
(95% CI)
AOR
(95% CI)
Practice of farmers about safe handling of pesticides
Unsafe 89 (23.6) 2.2 (1.4-3.3)* 2.1 (1.3-3.3)*
Safe 35 (12.2) 1 1
Education
Can read and write (literate) 75 (17.0) 1.3 (0.9-2.0)* 1.1 (0.7-1.7)*
Can't read and write/ only name 49 (22.2) 1 1
Discussion
The study assessed different aspects of chemical pesticides use by farmers of the Chitwan district, and
the self-reported health problems experienced by them. It addresses the research gap on factors
contributing to safe and unsafe practice at different stages of pesticide handling namely during purchase,
during mixing and spraying and during storage and disposal. Also factor such as perception of farmers
towards the market management, the role of local government and consumers to minimize pesticide is
less explored and hence this research article would provide a scientic basis to advocate for enabling
environment for the reduction of irrational use of chemical pesticides in agriculture farming.
Rampant use of chemical pesticide in Chitwan
An important revelation of the study is that 84 percent of the farmers in Chitwan are currently using
exclusively chemical pesticides. Less than four percent are using botanical pesticides. It is likely that
farmers are using botanical pesticides in small scale farming and in vegetable production for self-
consumption. Chemical pesticides are widely used in commercial agriculture products, which are
consumed by the larger consumers from the local and distant markets. As the study revealed, more than
60 percent of the farmers have been using chemical pesticides for more than 10 years, which means that
farmers and general population have been exposed to chemical pesticides for a very long period of time.
Two percent of the farmers use chemical pesticides labeled red which are banned in Nepal due to their
extreme hazardous effect in health. This is a matter of serious concern that these pesticides are still

Page 12/19
available in the market and used by some farmers, as also suggested by other studies from Nepal [23].
This indicates towards an urgent need for monitoring the pesticide market.
Safe handling of pesticides by the farmers
We studied the practice of pesticide use in three parts – during purchase; during mixing and spray; and
storage and disposal. And in all the three possible stages of exposure, they did not practice safe handling
of the chemical pesticides.
Label of pesticides is a critical marker of hazardousness of pesticides. Only a quarter of farmers observed
the label of pesticide during purchase and 16.9% observed waiting time of the pesticide during purchase
indicates the unawareness of farmers about safety provisions during purchase of pesticides. Similar
ndings have been observed in Kavrepalanchok [24] and Chitwan [25] where low levels of education and
awareness among farmers posed diculty to farmers to read the instructions in the international
language. A study from Kuwait also depicted a similar scenario where 70% farmers did not go through the
instructions in the pesticide container and education level was associated with it [26].
During mixing and spraying of the pesticides, less than half of the farmers followed safe practices.
Wearing protective clothes is one of the common safety measures. The study found that 54 percent of the
farmers used any of the protective clothes during mixing and spraying of the pesticides, similar to that of
(Kuwait (58%) [26]. However, safe practice is better than in Northern Tanzania [27] where less than 10
percent farmers were completely covered during spray.
Less use of protective clothes in Chitwan district might be due to the lack of awareness among the
farmers, lack of availability when needed, discomfort due to hot and humid climate and possibly might be
due to cost factor.Similar ndings have been shown by other studies [28-30] where cost, discomfort and
tropical factors were sought as major reasons for not using PPE. In Chitwan, Nepal, where the climatic
condition is very hot, the cost of PPE ranges from NRs. 3500 to 5000 and are often not available in the
local market. Government should consider programs to increase the availability and accessibility of
farmers to personal protective equipment.
Practice of safe storage is followed by the majority of the farmers in Chitwan district, as the study
revealed that 90% of them stored pesticides in a separate place away from access of children and
animals. Storage practice in Chitwan is better than in Sri Lanka where 76% of farmers stored inside the
house or immediately outside the house [31]. Nearly three-fourth of farmers dumped pesticide containers
without consideration of their hazardous impact on the environment and humans, similar to that of
Southwest Nigeria (72%) [32], probably due to lack of awareness and ignorance. Indeed, farmers have
been reported to be ill-informed and insensitive to health and environmental hazards due to unsafe
disposal of pesticide containers [33].
Factors affecting safe practice of pesticides

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Overall safe practice of pesticides during purchase, spray, storage and disposal was signicantly
associated with gender, literacy status, knowledge and perception of the farmers in multivariate logistic
regression. Male, literate farmers were more careful during purchase compared to female and illiterate
farmers. Association of literacy status of farmers and knowledge with safe practice during purchase can
be logically explained, as done by a systematic review conducted between 1999 and 2019 with 121
articles [34]. Also from the present study, gender and literacy status were found signicantly associated
where 73.0% males were literate as compared to 63.3% literacy among females, therefore it is more likely
that gender could be a confounding variable for higher knowledge among males with regards to
pesticides. Besides, high exposures to the media and outside environment for males could also be a
potential explanation as found in a Chinese study [35].
In this study, knowledge of farmers about pesticide handling is strongly associated with safe pesticide
use practice for all the three stages (purchase, use, and disposal). This nding of the study is consistent
with the results of many other studies conducted in different countries [21, 29, 36], indicating the need for
various programs to increase knowledge of farmers about safe practice of pesticides.
We explored the perception of farmers about the existing situation of pesticide use and their view on the
role of different stakeholders, which is crucial in promoting rational and safe use of pesticide. We found
that the overall perception of the farmers is positive and favorable to promote rational use of chemical
pesticides. Farmers are concerned about the role of government, and have expressed that the government
should provide subsidy and provide a separate market for organic/IPM products. It is encouraging that
86% of farmers are willing to search for alternatives to chemical pesticides and 88% of them prefer
organic farming. These ndings are similar to the studies [37-39] which have shown policies and
legislation to support market returns and information acquisition had a signicant positive inuence on
standardized pesticide application.
Health effects on the farmers
The study revealed that one-fth of the farmers had experienced one or more acute health problems
related to pesticide during the previous year. Among them, dizziness and headache, skin allergies and
burning of eyes were the most common symptoms. These are most common acute health problems due
to exposure to chemical pesticides, reported elsewhere in Nepal [13, 40] as well and other countries [41-
43]. The acute problems were signicantly higher among those with unsafe spray practice, which is
similar to that of other parts of Nepal [13] indicating the need to promote safe handling of pesticides by
the farmers. Furthermore, the majority of farmers with acute health symptoms did not attend any health
facility accepting that such health problems are normal to the farm workers, a nding common to other
developing countries as well [44].
Limitation And Strengths
Field verication on practice for each respondent was not performed. However, the paper has rmly
assessed the practice of farmers and its associated factors at different stages of pesticide handling. Also

Page 14/19
health problems experienced by the farmers were based on recall for one year period and can be affected
by recall bias. We tried to reduce this bias through probing on the types, severity of symptoms and how
they responded to it. Besides, nding on the perception of farmers towards chemical pesticide policy and
market management would be a new outlook to motivate farmers for safe practice along with the
enhancement of their knowledge.
Conclusion
There was a high use of pesticide in agriculture farming in Chitwan District. Improving knowledge of
farmers on safe handling of pesticides and developing strategies for proper market management would
promote the safe handling practices among farmers and reduce the acute pesticide poisoning in Nepal.
List Of Abbreviations
AOR : Adjusted Odds Ratio
CI : Condence Intervals
CISU : Civil Society in Development
COR : Crude Odds Ratio
CSPro : The Census and Survey Processing System
DASAM : Danish Society of Occupational and Environmental Medicine
IBM : International Business Machines Corporation
IPM : Integrated Pest Management
MRLs : Maximum Residue Limit
NPHF : Nepal Public Health Foundation
SPSS : Statistical Package for the Social Sciences
Declarations
Ethics approval and consent to participate
The authors were granted an ethical approval letter from the Ethical Review Board of Nepal Health
Research Council. The written consent was obtained from the study participants.
Consent for publication
Not applicable.
Availability of data and materials

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The data that support the ndings from this study are available from NPHF but restrictions may apply to
the availability of these data, and are not publicly available. Individual applications for data access may
be made using the following link:
https://drive.google.com/le/d/1i4Cq5mzWav5bLhaMwfIp6ZEBtICLmpWy/view?usp=sharing
Competing interests
There is no competing interest.
Funding
CISU funded a project entitled 'Farming, Health and Environment' to NPHF which had a component to
conduct research in the eld of pesticide and health.
Authors' contributions
SK analysed the data set and drafted a manuscript. AV worked to present the ndings in a coherent way.
BP worked to nalize the methodology drafted; EJ worked to nalize the discussion and SO reviewed all
sections of the article. All authors read and approved the nal manuscript.
Acknowledgements
We are thankful to the farmers as study participants and local authority for facilitating this study.
Similarly, we acknowledge NPHF for integrating this study in its programme activities. We appreciate the
efforts of Sunil Dulal, Dr. Amrit Pokharel and Usha Neupane for coordinating and supporting the eld
work. We thank Diálogos and DASAM, our implementing partners for collaborative work on the issue of
pesticide and health.
References
1. World Health Organization: Preventing disease through healthy environments. In
.
Geneva,
Switzerland: WHO; 2019: 1.
2. WHO, FAO: Global situation of pesticide management in agriculture and public health. In
.
; 2018.
3. [http://www.fao.org/faostat/en/#data/RP/visualize]
4. [http://www.fao.org/economic/ess/environment/data/en/]
5. Ghimire K, GC A: Trend of Pesticides Uses in Nepal.
Journal of the Plant Protection Society
2018, 5.
6. Sushma D, Dipesh R, Lekhendra T, Ram SS: A review on status of pesticides use in Nepal.
Research
Journal of Agriculture and Forestry Sciences ____________________________________________ ISSN
2015,
2320:6063.
7. Dawson AH, Eddleston M, Senarathna L, Mohamed F, Gawarammana I, Bowe SJ, Manuweera G,
Buckley NA: Acute human lethal toxicity of agricultural pesticides: a prospective cohort study.
PLoS

Page 16/19
Med
2010, 7(10):e1000357.
8. Gyawali K: Pesticide Uses and its Effects on Public Health and Environment.
Journal of Health
Promotion
2018, 6:28-36.
9. Pesticide residues in food [https://www.who.int/news-room/fact-sheets/detail/pesticide-residues-in-
food]
10. Bhandari G, Zomer P, Atreya K, Mol HG, Yang X, Geissen V: Pesticide residues in Nepalese vegetables
and potential health risks.
Environmental research
2019, 172:511-521.
11. Gyenwali D, Vaidya A, Tiwari S, Khatiwada P, Lamsal DR, Giri S: Pesticide poisoning in Chitwan,
Nepal: a descriptive epidemiological study.
BMC public health
2017, 17(1):619.
12. Human Health Issues Related to Pesticides [https://www.epa.gov/pesticide-science-and-assessing-
pesticide-risks/human-health-issues-related-pesticides]
13. Lamichhane R, Lama N, Subedi S, Singh SB, Sah RB, Yadav BK: Use of pesticides and health risk
among farmers in Sunsari district, Nepal.
Journal of Nepal Health Research Council
2019, 17(1):66-
70.
14. Jørs E, Neupane D, London L: Pesticide poisonings in low-and middle-income countries. In
.
: SAGE
Publications Sage UK: London, England; 2018.
15. MoHP: National Health Policy 2019. In
.
; 2019.
16. Health related Policy and Program for Fiscal Year 2076/77
[https://www.publichealthupdate.com/health-related-policy-and-program-for-scal-year-2076-77/]
17. Damalas CA, Koutroubas SD: Farmers’ exposure to pesticides: toxicity types and ways of prevention.
In
.
: Multidisciplinary Digital Publishing Institute; 2016.
18. Damalas CA, Koutroubas SD: Farmers' behaviour in pesticide use: A key concept for improving
environmental safety.
Current Opinion in Environmental Science & Health
2018, 4:27-30.
19. Rijal JP, Regmi R, Ghimire R, Puri KD, Gyawaly S, Poudel S: Farmers’ knowledge on pesticide safety
and pest management practices: A case study of vegetable growers in Chitwan, Nepal.
Agriculture
2018, 8(1):16.
20. Daniel WW, Cross CL: Biostatistics: A Foundation for Analysis in the Health Sciences 10 edn: Wiley;
2013.
21. Taghdisi MH, Besheli BA, Dehdari T, Khalili F: Knowledge and practices of safe use of pesticides
among a group of farmers in northern Iran.
The international journal of occupational and
environmental medicine
2019, 10(2):66.
22. Mubushar M, Aldosari FO, Baig MB, Alotaibi BM, Khan AQ: Assessment of farmers on their knowledge
regarding pesticide usage and biosafety.
Saudi journal of biological sciences
2019, 26(7):1903-1910.
23. Adhikari PR: An overview of pesticide management in Nepal.
Journal of Agriculture and Environment
2017, 18:95-105.
24. Sapkota KR, Sapkota S, Sapkota S, Katuwal K: Pesticides handling practices among potato growers
in Kavrepalanchok, Nepal.
Journal of Agriculture and Natural Resources
2020, 3(1):77-87.

Page 17/19
25. Khanal G, Singh A: Patterns of pesticide use and associated factors among the commercial farmers
of Chitwan, Nepal.
Environmental health insights
2016, 10:EHI. S40973.
26. Jallow MF, Awadh DG, Albaho MS, Devi VY, Thomas BM: Pesticide knowledge and safety practices
among farm workers in Kuwait: Results of a survey.
International journal of environmental research
and public health
2017, 14(4):340.
27. Skjerve E: Self-Reported Symptoms and Pesticide Use among Farm Workers in Arusha, Northern
Tanzania: A Cross Sectional Study. 2017.
28. Bhandari G, Atreya K, Yang X, Fan L, Geissen V: Factors affecting pesticide safety behaviour: The
perceptions of Nepalese farmers and retailers.
Science of The Total Environment
2018, 631:1560-
1571.
29. Rostami F, Afshari M, Rostami-Moez M, Assari MJ, Soltanian AR: Knowledge, attitude, and practice of
pesticides use among agricultural workers.
Indian journal of occupational and environmental
medicine
2019, 23(1):42.
30. Shrestha P, Koirala P, Tamrakar A: Knowledge, practice and use of pesticides among commercial
vegetable growers of Dhading district, Nepal.
Journal of Agriculture and Environment
2010, 11:95-
100.
31. Mohamed F, Manuweera G, Gunnell D, Azher S, Eddleston M, Dawson A, Konradsen F: Pattern of
pesticide storage before pesticide self-poisoning in rural Sri Lanka.
BMC Public Health
2009.
32. Sosan M, Oladepo O, Ajibade T: Assessment of Pesticide Wastes Disposal Practices by Cocoa
Farmers in Southwestern Nigeria.
The Journal of Solid Waste Technology and Management
2020,
46(2):230-238.
33. Öztaş D, Kurt B, Koç A, Akbaba M, İlter H: Knowledge Level, Attitude, and Behaviors of Farmers in
Çukurova Region regarding the Use of Pesticides.
BioMed research international
2018, 2018.
34. Sapbamrer R, Thammachai A: Factors affecting use of personal protective equipment and pesticide
safety practices: A systematic review.
Environmental Research
2020:109444.
35. Wang W, Jin J, He R, Gong H: Gender differences in pesticide use knowledge, risk awareness and
practices in Chinese farmers.
Science of the Total Environment
2017, 590:22-28.
36. Mequanint C, Getachew B, Mindaye Y, Amare DE, Guadu T, Dagne H: Practice towards pesticide
handling, storage and its associated factors among farmers working in irrigations in Gondar town,
Ethiopia, 2019.
BMC research notes
2019, 12(1):709.
37. Organization WH: Vector control. In
.
: World Health Organization. Regional Oce for South-East Asia;
2017.
38. Jin J, Wang W, He R, Gong H: Pesticide use and risk perceptions among small-scale farmers in Anqiu
County, China.
International journal of environmental research and public health
2017, 14(1):29.
39. Wang J, Deng Y, Ma Y: Relationships between safe pesticide practice and perceived benets and
subjective norm, and the moderation role of information acquisition: Evidence from 971 farmers in
China.
International journal of environmental research and public health
2017, 14(9):962.

Page 18/19
40. Bhandari S, Paneru S, Pandit S, Rijal S, Manandhar HK, Ghimire BP: Assessment of pesticide use in
major vegetables from farmers’ perception and knowledge in Dhading district, Nepal.
Journal of
Agriculture and Natural Resources
2020, 3(1):265-281.
41. Sai MVS, Revati GD, Ramya R, Swaroop AM, Maheswari E, Kumar MM: Knowledge and perception of
farmers regarding pesticide usage in a rural farming village, Southern India.
Indian Journal of
Occupational and Environmental Medicine
2019, 23(1):32.
42. Mwabulambo SG, Mrema EJ, Ngowi AV, Mamuya S: Health symptoms associated with pesticides
exposure among ower and onion pesticide applicators in Arusha region.
Annals of global health
2018, 84(3):369.
43. Miyittah MK, Kwadzo M, Gyamfua AP, Dodor DE: Health risk factors associated with pesticide use by
watermelon farmers in Central region, Ghana.
Environmental Systems Research
2020, 9:1-13.
44. Lekei EE, Ngowi AV, London L: Farmers' knowledge, practices and injuries associated with pesticide
exposure in rural farming villages in Tanzania.
BMC Public Healh
2014.
Figures
Figure 1
Knowledge, practice and perception of farmers about pesticide use and its safe handling

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Figure 2
Health problems experienced by farmers
Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download.
Additionalle1.pdf