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DOI: 10.1590/1413-81232018247.

19282017 2569

Effects of pesticides on rural workers: haematological parameters

temas livres free themes

and symptomalogical reports

Efeitos dos pesticidas sobre trabalhadores rurais: parâmetros

hematológicos e relatos sintomatológicos

Juliana Dalbó (https://orcid.org/0000-0001-5088-5466) 1

Lívia Alves Filgueiras (https://orcid.org/0000-0001-5689-4961) 2
Anderson Nogueira Mendes (https://orcid.org/0000-0002-9778-3667) 2

Abstract Exposure to pesticides by the rural pop- Resumo A exposição a pesticidas pela população
ulation is increasing worldwide. Pesticides can rural está crescendo em todo o mundo. Os pestici-
induce the development of different diseases such das podem induzir o desenvolvimento de diferen-
as cancer and diseases of the central nervous sys- tes doenças, como o cancer e as do sistema nervoso
tem. This study analysed the clinical symptoms central. Este estudo analisou os sintomas clínicos
and haematological changes of a rural population e alterações hematológicas de uma população ru-
in Conceição do Castelo, Espirito Santo, Brazil. ral em Conceição do Castelo, Espírito Santo, Bra-
For evaluation of symptomatology exposure to sil. Para a avaliação da exposição a pesticidas e
pesticides, 142 rural workers were interviewed. sintomatologias, 142 trabalhadores rurais foram
Of these, 22 workers were selected for haemato- entrevistados. Destes, 22 trabalhadores foram
logical tests randomly as to evaluate haemato- selecionados de randomicamente para testes he-
logical changes during the period of exposure to matológicos e avaliação de alterações hematológi-
pesticides. Haematological analyses showed that cas durante o período de exposição a pesticidas.
erythrocytes, haemoglobin, haematocrit, mean Análises hematológicas mostraram que eritrócitos,
corpuscular (VCM) volume, mean corpuscular hemoglobina, hematócrito, volume corpuscular
haemoglobin (MCH), mean corpuscular hae- médio (VCM), hemoglobina corpuscular média
moglobin concentration (MCHC) are in accord- (HCM), concentração de hemoglobina corpuscu-
ance with the reference intervals in haematology. lar média (CHCM) estão em conformidade com
Variations in the concentrations of rods and neu- os intervalos de referência. As variações nas con-
trophils indicates that exposure to pesticides in- centrações de bastonetes e neutrófilos indicam que
creases the amount of those cells. Haematological a exposição a pesticidas aumenta a quantidade
disorders in rural workers exposed to pesticides dessas células. Alterações hematológicas em tra-
Rede Nordeste de can be correlated with reported symptoms. The balhadores rurais expostos a pesticidas podem ser
Biotecnologia, Universidade results described in this study are relevant to the correlacionados com alguns sintomas relatados.
Federal do Espírito Santo.
Av. Fernando Ferrari 514, health public and reinforce the concern about the Os resultados descritos neste estudo são relevantes
Goiabeiras. 29075-910 indiscriminate use of pesticides. para a saúde pública e para reforçar a preocupa-
Vitória ES Brasil. Key words Haematological disorders, Health of ção com o uso indiscriminado de pesticidas.
Departamento de Biofísica
e Fisiologia, Universidade rural workers, Human poisoning, Organophos- Palavras-chave Alterações hematológicas, Saúde
Federal do Piauí. Teresina phorus, Pesticides do trabalhador rural, Intoxicação humana, Orga-
Piauí Brasil. nofosforados, Pesticidas
Dalbó J et al.

Introduction nation, along with excessive sweating, impaired

gastrointestinal motility and vomiting followed
Pesticides have been used since the 1950s in Bra- by paralysis12,17. Exposure to high doses of and
zil1,2. Between 2000 and 2010, the use of pesticides acute exposure to pesticides can result in death
increased 93% worldwide, while in Brazil, this due to respiratory failure8.
percentage reached 190%3. It is estimated that Organophosphorus is associated with neuro-
approximately 25 million workers are exposed toxic effects in which cognitive functions such as
to pesticides in developing countries alone4. Bra- psychomotor speed, performance of functions,
zil consumption doubled reaching the alarming visual skills and memory are affected. Exposure
index of 190%, making Brazil the leader of the may result in Parkinson’s disease, Alzheimer’s
world rankings since 20085. disease, amyotrophic lateral sclerosis, depression,
The organophosphorus class is a particularly suicide10,14,18,19. Organophosphorus can induce
relevant group of pesticides, as they have been in the formation of free radicals that interact with
use as insecticides since 19406. Organophospho- blood cells by changing haematological param-
rus are commercially used to control agricultural eters20.
pests and arthropod vectors of disease, for domes- The vast majority of papers published in the
tic purposes7,8. Insecticides may cause a variety of literature associate organophosphorus with in-
toxic effects on different living beings in the field, hibition of acetyl cholinesterase6,8,12,15-17,19, but do
mainly due to the presence of residual concentra- not discuss possible haematological changes in
tions arising from the repeated use of chemicals9. humans that are continuously exposed to such
Exposures to pesticides can be overt or subacute, products. Thus, it is necessary to investigate hae-
and the effects range from acute to chronic tox- matological parameters and correlate possible
icity7. effects of organophosphorus in humans.
Given the different forms of application and Despite the implementation of the Pro-
use of these products, a large number of people gramme for Pesticide Residue Analysis in Food,
around the world are routinely exposed to toxic several farmers and Brazilian consumers are
levels. In 2008, pesticides were the ninth most exposed to pesticides, which increases the like-
common substance reported in poison control lihood of developing diseases resulting from
centres, and approximately 45% of all pesticide the contact with these products3. Pomeranian
poisonings were reported in children10. communities from the brazilian State of Espíri-
Although pesticides are widely used as a crop to Santo, such as those from the regions of San-
protection product, they can have significant ad- ta Tereza and Santa Maria de Jequitibá, usually
verse effects on “non-target” species, including use pesticides indiscriminately2. Accordingly, this
humans6. These adverse effects include possible study aimed to investigate and trace the profile
long-term effects of chronic low-level exposure, of a community from the south of Espírito Santo
developmental toxicity and neurotoxicity, in ad- regarding the exposure to and use of pesticides
dition to possible pathophysiological actions that to investigate possible symptoms and pathophys-
have not yet been described in the literature8,11. iological characteristics associated with mild or
These pathophysiological may be preceded by overexposure to organophosphorus and other
general symptoms, such as eye irritation, lacri- pesticides.
mation, headache, skin lesions, nausea, dyspnoea,
tingling, cramps, muscle pain, depression, and
others3,6,12. Long-term exposure can cause contact Materials and methods
dermatitis symptoms, such as erythema, burning,
itching, vesicles and eczema, and corrosive lesions Epidemiological study of the population
of the oral, oesophageal and gastric mucosa9,13-16. using an assessment questionnaire
The damages caused by pesticides constitute
a very serious public health problem, particu- The study population consists of several fa-
larly regarding the health of both farmers and mily groups, with a total of 142 people residing
consumers3. These compounds can be absorbed in the Mata Fria community, in the rural area of
through the skin, mucous membranes, gastroin- Conceição do Castelo-Espírito Santo, who use
testinal tract and respiratory causing poisoning pesticides in agricultural activities. The partici-
in farm workers, producing high morbidity and pants included individuals of both genders aged
mortality17. Less severe exposures may cause ex- between 15 and 82 years old. They were evaluated
cessive salivation, lacrimation, and frequent uri- with a questionnaire aimed at identifying possi-

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019

ble correlations between exposure to pesticides 0.001 and **** p < 0.0001 were considered statis-
and the symptoms arising from this exposure. tically significant.

Blood collection and complete blood count

Rural workers were randomly selected from
the study population for the blood tests before Table 1 shows the main pesticides used by farm-
and after the growing season. During the harvest ers in the region of Conceição do Castelo, Espírito
period, 22 workers were tested. After the end of Santo. Roundup is used extensively as an herbi-
the harvest period, only 22 workers were tested cide for all farmers in order to combat the growth
because they were the only ones who had direct of weeds. The Aminol and Gramoxone pesticides
contact with pesticides during this period. The are used also in large quantities by some farmers.
same 22 rural workers were used for analyzes be- Farmers still use insecticides and fungicides as the
fore and after harvest. Verdadeiro and Lannate. Variability of chemical
Peripheral blood was collected from the me- groups of pesticides is an item that should be con-
dian cubical vein of the participants with a 3-mL sidered as interference in the health of rural work-
syringe and placed in 3-mL tubes containing 5% ers who are directly exposed to these products.
ethylenediaminetetraacetic acid (EDTA). After Table 2 shows the level of education that
collection, the blood was placed into a homoge- rural workers have regarding the handling of
niser, followed by a blood smear. For that purpo- pesticides. As described in section 2, workers an-
se, a small amount of blood that was in the test swered a questionnaire in order to assess whether
tube was pipetted onto a slide labelled with the they know to handle properly the pesticides and
rural workers’ identification data. Another slide what the purpose of use of purchased pesticides.
(spreader) was used at an angle of 45° to draw According to Table 2, they do not receive infor-
back against the drop of blood, filling the slide to mation about the dangers of pesticide use in the
the edges and obtaining a smear. field and what damage pesticides can cause to the
The slides with the smears were staining by health of workers. The way of manipulation of
immersing them in fixative solution with ethanol pesticides is inadequate and much of the popula-
(10s). Next, the slides were removed and immer- tion works with pesticides for over 10 years. The
sed in haematoxylin for visualisation of blood workers do not adequately utilize safety equip-
cells (10s) and then in eosin for staining leucocy- ment for handling of pesticides.
tes (15s). Slides were visualised on a Nikon Eclip- Table 3 shows the general information on the
se E200® microscope. The blood cell count was exposed workers. Rural workers have low educa-
performed in the BC-2800 Mindray® apparatus tion, with most males above 30 years. Most work-
using the whole blood collected in EDTA-contai- ers are not smokers and do not consume alcohol.
ning tubes to check for changes in blood cell cou- Table 4 shows which symptomatology rural
nt. Serum ALT, AST and butyrylcholinesterase workers say present, especially when they are in
(BChE) were analyzed using commercial Dolles the collection, handling or not pesticides. The
brand kit. variability of symptoms is extensive. However,
This study was conducted according to the most workers complain of eye irritation, head-
recommendations of the Resolution 466/12CNS/ aches, joint pain, muscle pain.
MS and was approved by the Human Research Figure 1 shows the haematological analysis
Ethics Committee of the Federal University of Es- performed on 22 rural workers before and after
pírito Santo. the harvest period, to evaluate possible interac-
tions of pesticides with blood cells. The hema-
Statistical analysis tologic analyzes show slight variation in leuco-
cyte number, band neutrophils, neutrophils and
All variables were compared using the Stu- platelets.
dent t test (P-valor <0.05 was considered statisti-
cally significant). Data were analysed using Gra-
phPad Instat software (GraphPad Software Inc., Discussion
version 6.0). Values are presented as mean ± s.d.
Differences between experimental groups were Brazil is the third largest consumer of crop pro-
evaluated by the two-tailed unpaired Student’s t tection products in the world and the first in Lat-
test. A * p value < 0.05, ** p value < 0.01, *** p < in America. The Southeast and South of Brazil
Dalbó J et al.

Table 1. Pesticides used by the population in Conceição do Castelo, Espírito Santo. The table describes the
trademarks (Brand name) used by rural workers, the most common Class of pesticides used, the Chemical group
of the commercial pesticides used, the Manufacturers of pesticides and the number of workers (%) using each
product as a percentage.
Brand name
Class Chemical group Manufacturer %
Active principle
Roundup Herbicide Organophosphorus Monsanto Company / 100
N-(phosphonomethyl)glycine USA – United States
Aminol Herbicide Dipyridylium Syngenta Limited – 56.3
2,4-dichlorophenoxyacetic acid United Kingdom
Gramoxone Herbicide Phenoxyacetic acids Milenia agro ciências 47.2
1,11-dimethyl 4,41-bipyridyl S/A – Londrina
Folicur Fungicide Triazole Bayer Crop Science 5.6
(RS)-1-p-chlorophenyl-4,4-dimethyl- AG – Germany
Fegatex Fungicide, Ethylbenzalkonium PRTrade Tecnologia 5.6
benzalkonium chloride Bactericide chloride Indústria Química e
and Farmacêutica Ltda -
sporicide São Paulo
Flex Insecticide Oxime methylcarbamate E. I. du Pont La Port 5.6
Diphenyl ether Plant – Texas
Targa Insecticide Neonicotinoid + Cyproconazole 4.9
Ethyl (R)-2-[4-(6-chloroquinoxalin-2- and Triazole technical: Switzerland
yloxy)penoxy]propionate fungicide Bayer AG
Verdadero Herbicide Diphenyl ether Zhongzha Branch 0.7
3-(2-chloro-1,3-thiazol-5-ylmethyl)- Jiangsu Changqing
5-mehtyl-1,3,5-oxadiazinan-4-ylidene Agrochemicals Co.
(nitro)amine Ltd. - China
Lannate Herbicide Aryloxyphenoxypropionic Nissan chemical 0.7
S-methyl N-(methylcarbamoyloxy) acid industries, LTD –
thioacetimidate Japan

consume approximately 38.9% and 31.2%, re- in Table 1. Roundup contains 41% glyphosate as
spectively, of the amount of these products used the isopropylamine salt and polyoxyethylenea-
in the entire country21. These regions are the mine (POEA) 15%23. This product is considered
largest Brazilian consumers and are, therefore, very efficient in combating weeds in coffee planta-
the focus of attention of surveillance agencies tions. According to the assessment, coffee growing
for the control of the indiscriminate use of such is the main agricultural activity in the municipal-
products. According to the Brazilian Institute of ity. During the course of the research, it was iden-
Environment and Renewable Natural Resources tified that the rural community of Conceição do
(IBAMA), Brazil primarily consumes the her- Castelo has direct and indirect contact with pesti-
bicides glyphosate (76%), 2,4-dichloropheoxy- cides of the chemical groups: organophosphorus;
acetic acid (2,4-D) and atrazine; the fungicides triazoles; pyrethroids and carbamates.
mineral oil, sulphur, and carbendazim; and the The rural workers replace organophospho-
insecticides cypermethrin (57%), methamido- rus with the chemicals phenoxyacetic acid or
phos and acephate22. bipyridylium to control weeds in corn and bean
The commercial product Roundup is the most plantations because, after seed germination, or-
used herbicide in Conceição do Castelo, as showed ganophosphorus can kill the corn and/or bean

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019

Table 2. Characteristics of the farms and pesticide Table 3. Socio demographic characteristics of rural
exposure among the rural workers from Conceição do workers.
Castelo. Variable N %
Variable N % Gender:
Receive an agronomic prescription: Male 102 71.8
Never/almost never 137 96.5 Female 40 28.2
Sometimes 5 3.5 Age group:
Places where the pesticides are 15-29 27 19.0
bought: 133 93.6 30-39 33 23.3
Agricultural stores 9 6.4 40-49 23 16.2
Other municipalities 50 or older 59 41.5
Disposal of the empty containers: Educational level:
Selective collection 70 49.3 Up to 4th grade 78 55.0
Burned 29 20.4 5th to 8th grade 45 31.7
Stored 65 45.7 Complete secondary school 18 12.6
Mode of exposure: Higher education 1 0.7
Preparing the spray mix 103 72.5 Know what PPE is:
Helping with the application 104 73.2 Yes 41 28.9
Cleaning the equipment 128 90.1 No 101 71.1
Contaminated clothing 111 78.1 Smoking habit:
Re-entering a contaminated area 142 100 Never smoked 131 92.2
Technical guidelines for the use of Smokes up to 10 cigarettes/day 9 6.4
pesticides: 117 82.4 Smokes more than 10 cigarettes/ 1 0.7
Directly from the vendor 12 8.4 day 1 0.7
Other person on the property 67 47.2 Former smoker
Neighbours and other friends Alcohol consumption:
Number of years of exposure to Never drinks 106 74.6
pesticides: 29 20.4 Occasional consumption/small 24 17.0
2 to 10 75 52.9 amount 11 7.7
11 to 20 38 26.7 Usual daily consumption of one to 1 0.7
21 to 30 two doses
PPE used: Usual daily consumption of three
None 69 48.6 doses
Boots 73 51.4
Hat 2 1.4
Protective clothing 7 4.9
Gloves 9 6.3
Pesticide respirators 7 4.9
ufactured in Brazil5. Because these products are
Equipment used for application:
essentially imported and despite the strict regu-
Knapsack sprayer 127 89.4
No equipment 15 10.5
lations imposed by the National Health Surveil-
lance Agency (ANVISA) and other supervisory
agencies, there is still a large release of such prod-
ucts because all of them are purchased in shops
for farmers without any control of the purchased
crops. Pesticides of the triazole, ethylbenzalkoni- The pattern of pesticide use in Brazil and in
um chloride, diphenyl ether and oxime methyl- the World is similar when comparing the class-
carbamate groups are typically used in tomato es and chemical groups applied in plantations.
crops. Although the farmers use other pesticides, Triazole pesticides, such as tebuconazole and
the organophosphorus chemical group is pre- myclobutanil, are widely used in Europe and
dominant in both coffee plantations and the Canada3. The National Health and Nutrition Ex-
preparation of the land for other crops. amination Survey (NHANES) has reported in-
Most of the products used by the farmers in toxications of Americans. Pesticide levels in car-
the Conceição de Castelo region in their crops pet dust and pesticide metabolites in the urine
are imported. Among the pesticides used by these of Washington state residents have increased in
farmers, only the Fegatex brand that belongs to individuals who own homes near orchard fields
the ethylbenzalkonium chloride group is man- and during the pesticide application season7.
Dalbó J et al.

Table 4. Symptoms resulting from pesticide exposure. tions. Pesticide residues chlorpyrifos, cyprodinil,
Symptoms N % dithiocarbamates, fenhexamid, fludioxonil and
Joint pain 91 64.1 tebuconazole were the most frequently detect-
Headache 94 66.2 ed in more than 4% of the analyzed samples24.
Eye irritation 83 58.4 Comparing the different regions of Brazil and the
Body (muscle) pain 79 55.6 world it is noticed that some chemical groups of
Cramps 56 39.4 pesticides are used by rural workers independent
Blurred vision 54 38.0 of the country of origin.
Tingling 48 33.8 The extensive use of such products has been
Nausea/gag reflex 43 30.3 considered dangerous and harmful to both the
Changes in blood pressure 40 28.1 producer and the consumer5,11. Some European
Shortness of breath/dyspnoea 40 28.1 countries, such as Germany, have been consider-
Excessive sweating 40 28.1 ably reducing the use of these products in rural
Heart palpitation 39 27.4 areas. At the same time, the production of pesti-
Impaired digestion 36 25.3 cide-free products known as “organic products”
Hepatitis 34 23.9 has increasingly grown in both farms and small
Lacrimation 33 23.2 production areas; these products are grown with-
Salivation 33 23.2 out the use of chemical pesticides; only manage-
Agitation/irritability 33 23.2 ment and the knowledge of mixed cropping are
Gastric inflammation 31 21.8 used to avoid using products with pesticides11.
Dizziness/vertigo 30 21.1
It must be noted that working with and
Abdominal pain 26 18.3
handling pesticides requires the use of personal
protective equipment (PPE). The analysis of the
Kidney disease 26 18.3
questionnaire data reveals that the farmers from
Shivering 20 14.0
the Conceição de Castelo region are directly and
Attention deficit 19 13.3
indirectly exposed to pesticides (Table 2). In a
Diarrhoea 18 12.6
brief analysis and by observing how the farmers
Liver Diseases 16 11.2
work, it can be noted that almost all of the pop-
Skin lesions/“allergy” 15 10.6
ulation do not properly use PPE: 51.4% of the
Sputum 11 7.7
142 interviewed workers use only boots; 48.6%
Cough 10 7.0
do not use any PPE; 6.3% use gloves; 4.9% use
Sputum 11 7.7
protective clothing and pesticide respirators; and
Asthma 9 6.3
1.4% use hats. A study conducted by Silva et al.25
Vomiting 8 5.6
in Campos Gerais in the Brazilian state of Minas
Arthrosis/osteoporosis 5 3.5
Gerais revealed that 95% of respondents report-
Respiratory diseases 4 2.8
ed the use of full PPE, which does not occur in
Cardiovascular diseases 2 1.4
Conceição do Castelo in the state of Espírito San-
Cancer 2 1.4
to.According to the NHANES program, farmers
Skin burns 2 1.4 in the United States are advised on the use of
pesticides. However, even guidance suggests that
many do not adequately use personal protective
equipment and ignore the risk of direct and indi-
rect contact with pesticides7. According to EFSA,
In Brazil, the Program for Analysis of Pesti- rural workers observed in 2013 are better follow-
cide Residues in Foods (PARA) investigates pes- ing the pesticide control and use standards due
ticide residues in food. Between 2001 and 2010, it to the rigid control of the European program24.
was found that 48.3% of products from the field The knapsack sprayer is the equipment used
were positive at least one pesticide residue. With- for pesticide application. During the preparation
in this study were found residues of organophos- of the spray mix containing the pesticides, the
phorus; triazoles; pyrethroids and carbamates3. workers spill it on both the equipment and their
The European Food Safety Authority (EFSA) hands and clothes, which allows the pesticides to
report describes that more than 97% of food in directly contact the skin. Products in powder form
the EU contains pesticide residues within the are easily blown towards the face of the worker
legal limits24. In plant products, 137 different who is preparing the product and towards the
substances were found in measurable concentra- bodies of other people who are in the same area.

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019

direct exposure period period without exposure

Erythrocytes, million/mm3

C Haemoglobin, g/dL D
Haematocrit, %

MCV, mm3

CHCM, g/dL
MCH, mm3

Figure 1. Hematological analysis of rural workers exposed to pesticides during the application period (direct
exposure period) and during the harvest period (period without exposure). * p value < 0.05, ** p value < 0.01,
*** p < 0.001 and **** p < 0.0001.

The product is applied during daytime hours with de Castelo’s farmers. Direct contact with skin,
high insolation. Some workers wash their equip- eyes and respiratory tracts leads to the acute poi-
ment in rivers that are used for other purposes, soning of farmers. These consequences are evi-
such as bathing, consumption, and laundry. dent according to the symptoms reported after
The surfactants present in the organophos- the exposure, such as headache (66.2%) and eye
phorus are irritating, corrosive and toxic for irritation (58.4%).
living beings and cause irritation and problems The prolonged use of these pesticides may
in the eyes, skin, and respiratory and digestive suggest symptoms of chronic poisoning. Among
tracts26. These symptoms were observed in the the respondents, the majority of them (52.9%)
data obtained in the evaluation of the Conceição have worked directly with pesticides for 11 to 20
Dalbó J et al.

direct exposure period period without exposure

Red cell distribution width (RDW)


Leucocytes, mm-3

Lymphocytes, %
Eosinophilis, %

Band neutrophilis, %
Monocytes, %

Figure 1. Hematological analysis of rural workers exposed to pesticides during the application period (direct
exposure period) and during the harvest period (period without exposure). * p value < 0.05, ** p value < 0.01,
*** p < 0.001 and **** p < 0.0001.

years; 26.7% have worked with them for 21 to 30 reuse them to transport water to be used for
years and 20.4% for 02 to 10 years. pesticide application and to store other uten-
Among the respondents, 96.3% reported sils. Additionally, some farmers store both emp-
that they buy their pesticides in the municipal- ty containers and containers with pesticides at
ity of Conceição do Castelo. This municipality home, which exposes the entire family. These
has a transfer station for the disposal of empty results differ from those obtained by Faria et
containers. However, only 49.3% of the farmers al.27 in a study conducted in the municipality
deliver these containers to the transfer station, of Bento Gonçalves in the Brazilian state of Rio
while 20.4% burn them and 45.7% store and Grande do Sul, where most workers handed over

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019


direct exposure period period without exposure

Segmented neutrophils, %


Neutrophils, % O
Platelets, 1000/mm3

Figure 1. Hematological analysis of rural workers exposed to pesticides during the application period (direct
exposure period) and during the harvest period (period without exposure). * p value < 0.05, ** p value < 0.01,
*** p < 0.001 and **** p < 0.0001.

the containers for selective collection (86.3%) According to the interviewed farmers, during
and received copies of agronomic prescriptions the purchase of the pesticides, the vendors provide
(84.6%)27. The lack of a public policy regarding information or guidance on how to handle the
the disposal of these materials and information, pesticides only if the buyer requests it. Some farm-
in the municipality of Conceição do Castelo, can ers also receive guidance from friends, neighbours
facilitate the development of diseases associated or other individuals working in the properties.
with contact with pesticides. The majority of the individuals exposed to
Among the rural workers, 96.5% do not re- pesticides are men (71.8% of the interviewed
ceive an agronomic prescription and may be using population) (Table 3). According to regulato-
the pesticides incorrectly, namely by using exces- ry standard 31 (NR-31) on health and safety in
sive amounts and then contaminating the envi- agricultural  work, item 31.8 prohibits children
ronment. Only 3.5% of the workers receive an under 18, individuals older than 60, and preg-
agronomic prescription, and 82.4% receive tech- nant women to directly or indirectly work with
nical guidelines about how to use the pesticides pesticides28. Within the group of individuals old-
from the vendors, who are not experts; therefore, er than 50 years, individuals aged 60 to 82 years
inappropriate purchases and prescriptions for were identified, while 19.0% of the population
problems encountered on their farms might be was aged 15 to 29 years. These data serve as a
obtained. warning because these individuals are more sus-
Dalbó J et al.

ceptible to poisoning resulting from exposure to Human exposure to pesticides is a serious

these pesticides because they are more sensitive public health problem worldwide, especially in
and have low immunity. developing countries31. The inappropriate use of
According to the study, 71.1% of the respond- pesticides has had several consequences for the
ents do not know what PPE is. The interview re- health of rural workers32,33.
sults indicate that many of these individuals have Poisoning is not always reported in Conceição
an educational level up to the 4th grade (55.0%), do Castelo because of the lack of laboratories
and some have completed primary education. with the necessary technology for quantifying
This factor serves as an alert for the implemen- and determining pesticide-derived substances
tation and promotion of an educational system in the blood. According to internal records of
that meets the needs of the farming communities the epidemiological surveillance department of
because the lack of information is due to the low Conceição de Castelo, 33 cases of poisoning were
level of education, thus impairing the individu- reported between January 2002 and September
al’s capacity to read and understand the severity 2013. In 2010, a total of 376 cases of pesticide
of being exposed to materials harmful to both poisoning were reported by the Toxicology Con-
their health and the environment. trol Centre (TOXCEN), while 218 cases were re-
The pesticides labels explain how to use them, ported by the Information System for Notifiable
application doses, storage, transportation and Diseases (SINAN) in the state of Espírito Santo.
some health problems resulting from incorrect It is believed that the number of pesticide
use of the products. Because the population has a poisoning cases is higher because there are no
low educational level, individuals may ignore the trained professionals in the rural areas to accu-
information and use the pesticides without the rately diagnose them. Accordingly, healthcare
necessary level of care, improperly and without teams need to be trained to improve diagnosis
protection, thus causing various health problems. and to introduce methodologies effective in con-
It is also noted that most workers do not firming that poisoning has occurred.
consume alcohol and do not smoke, which is a Including professionals with such expertise
positive aspect of this community. Alcohol con- in family health teams, especially in those cover-
sumption along with pesticide poisoning causes ing families from rural areas, for recognising and
high levels of liver and lung overload and neuro- managing the poisoning cases and also dissemi-
toxicity2. In Bento Gonçalves in the state of Rio nating guidelines for preventing or reducing the
Grande do Sul, alcohol consumption was report- effects of pesticide exposure are possibilities for
ed by 17.8% of men and 14.3% of women from minimising the impacts of the effects resulting
rural areas27. from the exposure to pesticides. Other proposals
Exposure to pesticides for long periods can may include partnerships with education entities
result in several liver, neural, and renal physiolog- that involve the training of rural school teach-
ical disorders29. To determine possible physiolog- ers about pesticides, expanding the scope of the
ical disorders due to the exposure to pesticides, guidelines for future farmers.
the farmers from the Conceição do Castelo re- Among the 142 respondents, 22 workers were
gion were assessed for symptoms resulting from randomly selected for haematological analysis.
acute and chronic poisoning by pesticides (Table Haematological analyzes suggest no changes in
4). In fact, analysis of the data for the assessed the characteristics and total number of red blood
rural community reveals that these workers also cells (Figure 1A-F). Rats exposed to pesticides
have some of the symptoms described above. show results, with decreases in erythrocyte count
The change in respiratory, eye problems, and mean corpuscular volume (MCV)34. Eryth-
gastrointestinal disorders and skin changes are rocyte count from 5.05 million/mm³ to 4.98 mil-
found in workers who use pesticide sprayers30. lion/mm³ is within the normal range. The MCV
The presence of different symptoms and condi- from 85.62 mm³ to 82.64 mm³ can suggest a re-
tions suggests the need for clinical monitoring duced synthesis of haemoglobin in the erythro-
of these individuals. The results suggest that the cytes that results in smaller cells (Figure 1D).
142 rural workers interviewed have symptoms of However, the red cell distribution width
chronic intoxication, due to exposure to pesti- (RDW) analyzed suggests changes in red blood
cides for long periods. The symptoms described cells, although not statistically significant (Figure
in Table 4 can be related to other disorders, but 1G). The RDW has been reported as an inde-
exposure to pesticides can also increase or ampli- pendent predictor of 30-day mortality in patients
fy any such damage. with organophosphorus poisoning35. Some stud-

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019

ies have shown that increasing RDW is associated of leucocytes. During the exhibition period it was
with the development of coronary artery disease, found that the number of white blood cells the
heart failure, stroke, peripheral artery disease36-39. patient was close to normal. However the harvest
The RDW also can also be related neurohormo- period, a reduction in the number of leucocytes
nal activation, renal dysfunction, thyroid disease, (Figure 1 H) was verified. Analyzing leucocyte se-
liver dysfunction, nutritional deficiencies, bone ries, it was found that lymphocytes, monocytes
marrow dysfunction, inflammatory diseases, and segmented neutrophils have not changed
chronic systemic inflammation or acute35. The (Figure 1 J, K, and M). It was not found the pres-
RDW cannot give accurate information to physi- ence of basophils, atypical lymphocytes, myelo-
cians on the inflammatory state and indication of cytes, metamyelocytes, blasts in farm workers.
the prognosis of patients with no other inflam- Figure 1-I suggests that there is a reduction in the
matory indicators40. number of eosinophils, but according to statisti-
In the case of rural workers, should be asso- cal analysis this difference cannot be confirmed.
ciated with the symptomatology observed with In the 90s, trichlorphon was reported as
the values ​​found here RDW serving with alert to organophosphorus insecticide capable of in-
the development of diseases associated with con- ducing leukopenia and decrease the amount of
tact with organophosphorus. RDW should be neutrophils and phagocytic capacity43. The data,
evaluated and followed up with other serum in- described in Figure 1, suggest decrease in the
flammatory markers to determine inflammatory amount of leucocytes and neutrophils. Possibly,
status and prognostic indication of patients40. In this reduction should be associated with expo-
parallel, biochemical markers of transaminases sure to different pesticides such as Roundup,
(AST and ALT) and BChE were analyzed in the which have in their composition different organ-
blood of rural workers. The values of AST, ALT ophosphorus. In relation to neutrophils, it was
and BChE were: 15.3 ± 3.9 U/L (direct exposure found that the amount of band neutrophils in-
period) and 14.9 ± 4.5 U/L (period without ex- creased (Figure 1L) while segmented neutrophils
posure); 12.2 ± .5 and 13.1 ± 3.9 U/L; 6.92 ± 2.3 remained proportional (Figure 1M).
(direct exposure period) and 7.12 ± 3.9 U/L (pe- There was a decrease in the number of neu-
riod without exposure). In both periods the re- trophils (Figure 1N). Little is known about the
sults did not present relevant variations. mechanisms involving metabolic and phagocyt-
The RDW levels are higher in rural workers of ic capacity in neutrophils as well as the produc-
Conceição do Castelo. High levels of RDW may tion of proinflammatory cytokines when there is
be related intense microcytosis; agglutinins of chronic poisoning organophosphorus44. Chronic
RBCs; production of red blood cells ineffective exposure to organophosphorus may modulate
as iron deficiency; Vitamin B12 or folate; high cholinergic antiinflammatory pathway, leading
lymphocyte count; the presence of giant platelets; to activation of muscarinic receptors and thereby
platelet aggregates; thrombotic thrombocytopen- modulating the immune-regulatory function of
ic purpura; underactive thyroid, kidney, liver, and the vagal nerve, the efferent vagal activation of
bone marrow; and inflammatory bowel diseases41. nerve fibers44,45. The decrease of the levels of neu-
RDW above 13% may indicate a high degree of trophils and eosinophils should be monitored
poisoning35. Workers investigated possessed values because these cells are involved in the body’s de-
near 13%, indicating a high degree of poisoning. fense system.
One possibility to increase the RDW is sub- According to figure 1O, platelets were within
clinical chronic inflammation that can occur by the normal range. However, the initial value of
a variety of mechanisms. In case of inflammato- 210,136.3 mm³ decreased to 197,857.1 mm³ after
ry processes there are changes in leucocytes. The exposure. Platelet activity is considered an initial
role of the immune system is to prevent tumour response in the regulation of haemostasis; their
onset and progression. Therefore, studies have most important functions include adhesion, ag-
been conducted to address the effect of pesticides gregation, and secretion. In addition, the pro-
on different parameters of immunity34. In vivo coagulant proteins are involved in haemostasis
and in vitro experiments have shown significant consolidation. Studies have shown an inhibition
reductions in the cellular and humoral immune of platelet aggregation, with a decrease in ATP
responses in cases of glyphosate exposure42. secretion by platelets caused by the mechanism
According to the description of the symptoms involved in the anti-platelet aggregation effect
presented by rural workers as a result of pesticide of glyphosate46. Studies with rural workers using
use, was expected to find changes in the number sprays of pesticides organophophorus report-
Dalbó J et al.

ed that there was a significant decrease in mean (Table 1) and may act in an additive or synergis-
haemoglobin, haematocrit and platelet count at tic manner on toxicity. Within the composition
the end of the day after use of sprays by rural of these pesticides are also carbamates, triazole
workers47. In theory, such factors could favour and others. The Gramoxone pesticide, for exam-
low immunity, with a higher chance of bleeding ple, has 1,1’-dimethyl-4,4’-bipyridine-dichloride
and other factors associated with haematologi- (Paraquat) in its composition and is associated
cal changes resulting in mild and severe medical with many problems of intoxication around the
conditions in rural workers. world, causing respiratory problems and neu-
The low level of education of rural workers rological damage48. In the long term, the use of
contributes to misuse of pesticides. The govern- Gramoxone in conjunction with Roundup could
ment and environmental organizations should lead to increased amplification of hematological
promote actions directed to rural workers so that and neurological injuries for any rural commu-
those using pesticides rationally without harm- nity that is in direct and indirect contact with
ing the environment. It was also observed that these pesticides49.
some individuals showed symptoms of acute and The results suggest the necessity of imple-
chronic poisoning. Haematological results show mentation and promotion of an educational
a significant variation which demonstrates the system that meets the needs of farming commu-
need for monitoring of rural workers to monitor nities and the need to provide appropriate train-
haematological disorders and other diseases as a ing for health workers in order to avoid future
result of direct contact with organophosphorus. impacts on community health and the environ-
Rural workers associate with Roundup oth- ment. These precepts are widely discussed not
er commercial products like Aminol, Gramox- only by the international academic community
one, Folicur, Fegatex, Flex, Targa, True, Lannate. but also by the government in order to reduce the
These pesticides are of different chemical groups use of pesticides in agriculture.


J Dalbó contributed in the development of the

project, in the review of the literature, analysis of
the data and writing of the article, LA Filgueiras
collaborated in the data analysis and revision of
the article and AN Mendes contributed in the de-
velopment of the project, literature review, data
analysis and writing of the article.J Dalbó con-
tributed in the development of the project, in the
review of the literature, analysis of the data and
writing of the article, LA Filgueiras collaborated
in the data analysis and revision of the article and
AN Mendes contributed in the development of
the project, literature review, data analysis and
writing of the article.

Ciência & Saúde Coletiva, 24(7):2569-2582, 2019


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