Abstract
INTRODUCTION: Acute pesticide poisoning (APP) continues to affect farm workers, especially in low- and middle-income countries (LMIC). The dose-response relationship between exposure and APP is well-researched, but pesticide exposure assessment in a practical environment is difficult to perform, considering various work practices and protections in place. It is well known that inadequate personal protective equipment (PPE) use is a risk factor of APP. However, it is unknown which types of inadequate PPE use, such as face or other types of general protection, are most harmful. METHODS: This study aimed to identify if inadequate PPE use is an indicator of APP risk following established specifications for meta-analysis of epidemiological studies. Included studies reported an odds ratio (OR) between PPE use to APP in agricultural workers. Data extracted from selected articles included authors, publication year, country of origin, farm type, population size, method of data collection and time frame of reported symptoms, job task, type of PPE and pesticides used, adjustments made in analysis, OR for APP, and 95% confidence intervals (CI). Meta-analysis was performed using a random effects model, where ORs were pooled to assess an overall estimate for poisoning odds. RESULTS: Our findings suggested that inadequate PPE use was associated with increased odds (OR = 1.57, 95% CI = 1.16-2.12) of having APP. Failure to use general protection and inadequate face protection increased odds of APP by 1.29 times (95% CI = 0.88-1.90) and 1.92 times (95% CI = 1.23-3.00), respectively. CONCLUSIONS: The meta-analysis results indicate that improper facial protection and general protection are not differently associated with APP odds. Our study concludes that more robust protection against inhalation and dermal contact are critical because any gaps in comprehensive full-body PPE would put workers and exposed populations at APP risk.