The Impact of Health Education Program about the Safe Use of Pesticides among Farmers at a Village in El-Minia City

Introduction:

A pesticide is a substance or mixture of substances intended for preventing, destroying, repelling or mitigating any pest, pesticides are usually used by farmers to prevent fungal invasion, insect damage, and the growth of unwanted (and often poisonous) plants. Pesticide has a positive benefit in terms of public health because fungi, insects and non-crop plants can contaminate crops with many natural toxins injurious to health (1).  Pesticides are widely used throughout the world, especially in agriculture for crop protection. Millions of farmers are exposed to danger by hazardous occupational practices and unsafe storage. Exposure to chemical pesticides is one of the most important occupational risks among farmers in the developing countries. Farmers can easily come in contact with the pesticides, for example, when mixing the chemicals or when applying them to the crops and when pesticide residues are carried to home (2).

Significant of study:

According to World Health Organization, each year, about 3,000,000 cases of pesticide poisoning and 220,000 deaths are reported in developing countries. About 2.2 million people, mainly belonging to developing countries are at increased risk of exposure to pesticides. Besides, some people are more susceptible to the toxic effects of pesticide than others, such as infants, young children, agricultural farm workers and pesticide applicators (Pesticides and Human Health (3). Nearly 80% of work force in Egypt are involved in agriculture and exposed to agriculture aerosols. Unlike other occupation they live in the same environment and thus exposure for them and their children continue over the weak. Agriculture workers and those living in rural environment are at increased risk of developing lung diseases (4).

Aim of the Study (It is two-folded aim):

• To assess the knowledge, attitudes, and self-reported practices regarding the safe use of pesticide among farmers in El-Minia city, Minia, Egypt.
• To assess the impact of health education program on the Safe Use of Pesticides for Farmers at a Village in El-Minia city. Egypt.

Research hypothesis:

Implementation of health education program regarding the safe use of pesticide among farmers in a village of El-Minia city will improve the knowledge, attitudes, and self-reported practices of the study group.

Subjects and Methods

Research Design:

Quasi-experimental design (Pretest Post-Test) was utilized in this research study.

Research Setting:

The study was conducted in one randomly selected village of El-Minia city at minia governorate, Egypt. Simple random sample technique was used to select one village (Damaris village) in El-Minia city.

Sample of the study:

The sample size was estimated to fulfill the aim of the study, with a 95% level of confidence (error=5 %) and a study power of 80% (error=20%). By using the Epi-info computer software program the required sample size was 322 farmers.

Study Tool:

A Structured questionnaire was designed by the researcher regarding the safe use of pesticides after reviewing of literature related to the study topic; also this tool was adapted from other instrument used by Norkaew (2009) and some modification were done by the researcher. The tool contents were tested for validity by three experts in community health nursing and community medicine and modification were done accordingly to ascertain relevance and completeness.

This tool includes four parts:

1st part: Demographics characteristics

The first part was designed to assess demographic and occupational characteristics of the farm workers such as (age, level of education, experience, working hours

2nd part: Knowledge regarding using of pesticide, it consist of:-

• General knowledge regarding using of pesticide (10 questions)

(Knowledge of using pesticide, personal protective equipment, health effect of pesticides What is disadvantage of pesticide use, How to use the pesticide properly, When you want to buy pesticide, how do you consider, ……………..etc.).

• Knowledge regarding first aid of pesticide poisoning (8 questions)

(Routes of entering of pesticides to the body, S&s of pesticides poisoning, first aid of pesticides poisoning). A correct answer will give 1 score and 0 score for wrong answer. Scores Descriptions: - (Less than 59%) Low level, (60-80%) Moderate levels and (80-100%) High levels).

3rd part: Attitudes regarding using of pesticide (15 questions)

Farmers respond to 5 statements are a Likert’s scale. The rating scale is measure as follow: (Strongly agree=4, Agree=3, Neural=2, disagree=1 and strongly disagree=0).The scores were classified into 3 levels (Positive Attitude (80%-100%), Neutral Attitude (60%-80%), and Negative Attitude (Less than 59%).

4th part: Self-reported Practice of pesticide usage (23 questions)

This 4th. Part includes questions about self-reported practices; how often they use each personal protective equipment. There were 4 statements. The rating scale is measure as follow: Usually=4, Sometime=3, rarely=2, Never=1. These classified into 3 levels (Good Practice (80%-100%), Fair Practice (60%-80%) and Poor Practice (Less than 59%).

Content Validity:

The content validity of the data collection tool was determined through an extensive review of national and international literature related to safe use of pesticides. The 4 parts of the tool were submitted to three experts in community health nursing and community medicine to test their validity. The tool was examined for content coverage, sequence of items, clarity, relevance, applicability, wording, length, format, and overall appearance. Based on experts` comments and recommendations; minor modifications had been made such as rephrasing and rearrangements of some sentences.

Reliability:

The internal consistency of the questionnaires was calculated using Cronbach's alpha coefficients. Test-retest was used. The Cronbach’s alpha of the questionnaires were 0.87, 0.97 and 0.96 respectively indicate good reliability.

Pilot study

To assess the clarity, reliability and applicability of the study tools which was used in the study for data collection; a pilot study was conducted on 10% of the sample. The results of the pilot study was helped in the necessary modifications of the tools in which omission of unneeded or repeated questions, adding missed questions will be done.

Statistical Analysis

Statistical package for the social science SPSS version 21 was used for statistical analysis of data, as it contains the test of significance given in standard statistical books. Collected data was summarized and tabulated.

Ethical consideration

Informed verbal consent will be obtained from farmers to be included in the study. It was included full explanation of the sheet, rights for privacy, confidentiality and rights to withdraw at any time.

Procedure

• A review of the related literature which was covering various aspects of the problem has done, using different books, journals and web sites, to get acquainted with the research problem and to implement the study
• An official permission taken from the dean of the faculty for conducting the study.
• An official letter from the faculty of nursing was delivered to the director (s) of the intended study setting (agricultural unit in the selected village).
• Verbal informed consents were obtained from all the farmers before the program enrollments. After that; a detailed explanation on study objectives was done.
•  The program lasted for 6 months; the study started at the beginning of September 2016, and was completed by the end of February 2017.
• Data were collected from each farmer individually before the implementation of the program for pretest was collected by using the previous mentioned study tool. These lasted for 20 to30 minutes for each one; The researcher divided the farmers into ten groups related to their time which was not interfere with their work time, Each group was from 30 to 32 farmers each session was conducted for about two to three hours for each group in agricultural unit of the Damaris village. then the researcher has agreed with farmers on the date of assembly for each group at the agricultural unit (ElGamaia ElZeraia) in the village of Damaris to implement the sessions of the health education program.
• The program sessions were consist of 5 sessions for each farmers ‘group using of a variety of teaching methods such as group discussion, lectures, role play and teaching videos each session lasted for 15-30 minutes with total time duration of three hours for each group started from 9 am to 12 midday. The researcher conducted the same previous sessions for the other 9 groups in the same way with different date suitable to farmers’ time.
• At the beginning of each session; the objective of the session explained. Also Feedback was done about the previous session and the content of the session were dealt using different ways of teaching. While the practical part of the teaching program was done for each session that corresponding with session contents
• Each session followed by a summary of essential points.
• At the end of program sessions, data were immediately collected using the study tool as a post-test, after three months also data were collected for follow-up test to show the effectiveness of the implemented program.

Results

Table (1) Distribution of the studied sample pesticides farmers according to their socio- demographic characteristics: (N. =322):-

Table (1) showed that socio demographic characteristics of pesticides' users, nearly half (48.8%) of pesticides' farmers were in the age group from41-60 years with mean age Mean ± SD 47.7± 8.3, 53.4% of farmers were illiterate and 64.6% of the respondents had an income less than 2000 bound. years of exposure to pesticides (<10years) were(43.8%), and (76.7% ) have no previous training about safe use of pesticides, and nearly half  of participants (52.8%) take their information about the pesticide from pesticides salesman.

Fig.1 illustrate that The total KAP mean scores at different levels of study, there was a significant improvement (P < 0.001) in the total KAP mean score during posttest (7.53±1.056) and follow-up test (7.26±1.261) as compared to pretest (3.51±.858). Knowledge scores significantly improved from (2.8±0.41) in posttest to (2.0±0 .34) in follow-up test as compared to (1.35±0.62) in pre-test. Also there was a significant improvement in attitude score from (2.85±0.35) in posttest to (2.8±0.41) as compared to pretest (1.13± 0.34). And there was a significant improvement in practice score from (2.1±0.6) in posttest to (2.1±0.6) in follow-up test as compared to pretest (1.01±0.12).

Table (2) Correlations between knowledge, attitudes and reported practices of farmers after implementation of the health education program

Table (2) revealed that there were positive statistically significant correlation between knowledge, attitudes and self-reported practices of pesticides’ farmers after implementation of health education program.

Table (3): The relationship between total knowledge and socio-demographic characteristics before and after the implementation of the program (N=322):-

N.B * F-value       ** T-value

Table (3): Shows that there were highly statistical significant differences between total knowledge and socio demographic characteristics of the studied sample related to age in pretest only, and with level of education and previous training in pretest and posttest respectively.

Table (4): The relationship between total attitude and socio-demographic characteristics before and after the implementation of the program (N=322):-

N.B * F-value       ** T-value

Table (4): Indicates that there were highly statistical significant differences between total attitude and socio demographic characteristics of the studied sample related to age, level of education, status in family and previous training in pre and posttest respectively.

Table (5): The relationship between total practice and socio-demographic data before and after the implementation of the program (N=322):-

N.B * F-test      ** T-test

Table (5): Denotes that there were highly statistical significant differences between total practice and socio demographic characteristics of the studied sample related to age group, level of education, Status in family and previous training in pre and posttest respectively.

Table (6): Multiple linear regression analysis illustrates the effect of different variables on pre and posttest total mean score of knowledge, attitude and practice:

Regression used is linear regression (R2 for knowledge=0.28 & 0.04) (R2 for attitude=0.59 & 0.12) (R2 for practice= 0.13 & 0.56).

In table (6) illustrates that the level of user education and perceived previous training were the most effective predictors that enhance the knowledge of safe usage of pesticides in preprogram. Also the level of user education was the most effective predictor that enhance the attitude of safe usage of pesticides in pre and post-program. Regarding practice towards safe usage of pesticides; the level of user education, user income, and perceived previous training were the most effective predictors that enhance their practice in pre and post-program.