PARAQUAT EXPOSURE AMONG

FARMERS IN Agusan del Sur

Engr. Ana Trinidad F. Rivera

Supervising Health Program Officer
Occupational Disease Division
Disease Prevention and Control Bureau
Department of Health
 Commonly encountered toxicants,
UP-NPMCC, 2008 (N=3,931)
5% 4%
6% 21%
6%
7%

15%
9%
13% 14%

Alkali Kerosene Silver jewelry cleaner

Paracetamol Ethanol(beverage) Mixed pesticide
Alcohol(household) Acid Iron
Salicylates
 Commonly encountered toxicants among
children, UP-NPMCC 2008 (N=1,927)
5% 4% 4% 3% 26%
5%

8%

8% 15%
8% 14%

Kerosene Alkali Silver jewelry cleaner

Pyrethroids Alcohol(household) Paracetamol
Elemental mercury Salicylates Button batteries
Iron Jathropa
 EAMC Poison Center,
Poisoning Cases* CY 2007

• Number of patients seen – 417(1.14 patient/day)

• Number of patients admitted – 364
• Number of deaths – 7 (1.7%)
• Top 10 poisoning agents
• Cleaning agents (22.3%) industrial products (6.2%)
• Pharmaceuticals (19.9%) others (5.3%)
• Hydrocarbons (16.7%) personal care (2.1%)
• Pesticides (12.9%) mixed (2.1%)
• Food (10.6%) plant (1.7%)

No. of clinical toxicologist =1

 Poison Control and Information Centers,
Philippines
East
Avenue
UP-NPMCC
Medical
Rizal Medical Center
Center
Batangas
Western Regional
Visayas Medical
Medical
Center
Center
Eastern Visayas
Zamboanga Regional Medical
Regional Center
Hospital and Northern Mindanao
Medical Regional Medical
Center Center
 Incidence rates of pesticide poisoning

SOURCE YEAR NUMBER OF PESTICIDE INCIDENCE

POISONING RATE (per
100,000)
Department of
Health
1982-
1985
1,704 3.27
(12 regions)
NPCIS 1986-
1990
221 2.6
National
Capital Region
NPCIS 1986-
1990
166 4.08
Region XI
Department of
Health
1991-
1995
333 1.08
(10 regions)
Pesticide poisoning in selected hospitals in
four regions in the Philippines

Region # of Pesticide Populations (in

Poisoning millions)
Cases
Reported (%)
CAR 41 (12.58%) 1.35

Region II 118 (36.2%) 2.76

Region VI 35 (10.74%) 6.15

Region XI 132 (40.49%) 5.12

TOTAL 326 (100%)

 Paraquat
• Non selective contact herbicide
• Belongs to the bipyridil group of
pesticides (quarternary nitrogen
herbicide) for broadleaf weed control
• Philippines, use is allowed only in big plantations
because of its toxicity
• Crisquat, Cyclone, Dextrone, Dexuron, Gramoxone
Extra, Herbaxone, Ortho Weed and Spot Killer, and
Sweep
• LD50 values of 110 to 150 mg/kg in rats
• moderately toxic to birds and aquatic
organisms
• highly persistent in soil, with reported
field half-lives > 1000 days
• liquid formulations (emulsifiable
concentrate and soluble concentrate)
containing paraquat dichloride at or
above 276 g/l, corresponding to paraquat
ion at or above 200 g/l, RC Secretariat EXTOXNET
 Paraquat
• Acute as well as chronic effects
• Dermal damage- erythema, abrasion, blistering, ulceration,
fingernail changes

• Mucosal membranes - Eye pain, redness, tearing, oral

ulceration, dryness

• Pulmonary - pulmonary edema leading to fibrosis

 Health Assessment of Agusan del
Sur Farmers (December 2008)
• 15 farmers exposed to paraquat:
9 directly exposed
5 indirectly exposed
• Various ailments involving the eyes,
skin and lungs reported
• Abnormal laboratory findings
consisted of low hemoglobin,
reticulocytosis, eosinophilia, abnormal
Chest X-ray, abnormal simple
spirometry studies, (+) KOH stain
• Disease in 3 individuals can be
attributed to paraquat exposure.
 Agusan Farmers Exposed to Paraquat

• They were not wearing personal

protective equipment while
exposed to paraquat.

• There is no existing
occupational safety and health
program in the plantation.
 Paraquat Poisoning Cases
• 29 yo/female, non-intentional patient at Batangas
Medical Center with swelling of mucosa, CXR (+)
infiltrates, right middle lobe, with esophagitis
• Patient was managed symptomatically
• Dr. Norma Pacalso of the Benguet Provincial Health Office said there is
an increase in monitored cases of poisoning in the province. She said
from 39 cases in 2011, it rose to 48 in 2012. This year (2013), 21 cases
have already been recorded –
(http://bulatlat.com/main/2013/10/07/nationwide-ban-on-herbicide-
gramoxone-sought/#sthash.vZJcVcms.dpuf)
 Health and Environmental
assessment for paraquat exposure
Patin-Ay, Prosperidad, Agusan del Sur
 Demography of Farmers Examined

• Total farmers - 56 (45 males, 11 females)

• Mean age - 36.9 years old (19-69 years old)
• Majority reached high school level of education
• Patients examined were accredited pesticide applicators
except one
 Demography of Farmers Examined
Barangay Number
• Residence of farmers Lapinigan 13

• Most (60%) have resided in Tagbayagan 10

the current residence for Cabanatuan 9

over 20 yrs Bayuga 8

• Most (58.9%) residences Maligaya 6

were within 5 km of the Mate 6

plantation Others 4

Total 56
 Medical History
• Common illnesses reported
Illness Number reporting Illness

Allergy 8

UTI 5

HPN 4

• Among family members, HPN was most common, followed by

DM, PTB, renal disease and allergy
 Personal and Social History

• 30 (53.6%) were smokers

• 40/56 drank alcohol--40 males and 6 females

 Occupational History
Pesticide Number

Paraquat 56

Glyphosate 56

2,4 D 10

Pyrethroids 4

Malathion 2

Others (Butachlor, Endrin,

6
Endosulfan)
 Occupational History
Job Description Number

Mixing/Loading/Applying 35

Loading/Applying 9

Applying 11

Mixing/Applying 1

Total 56
 Occupational History
Type of PPE Number

Gauntlet gloves 53

Number Face mask 52

Apron 49
Use PPE 55
Goggles 45
Boots 44
No PPE 1
Coverall 25
Face Shield 18
Respirator 14
Occupational History: Work
Practices
Re-entry Number

Yes 6

No 40

No Data 10

Total 56
 Occupational History: Work
Experienced a
Practices
Number
Spill Activity During Spills Number
Yes 39
Back-pack Spraying 35
No 17
Loading 17
Total 56
Mixing 12

Aerial Spraying 22

Total 56
 Occupational History: Work
Pesticide Use at
Practices
Number
Home Knowledge learned
Number
Yes 16 from

No 31 Lectures 36

No Data 9 Co-workers 8

Total 56 Informal Talks 7

Self learning 2

Reading materials 1

No Data 5
 Occupational History: Work
Pesticide Storage
Practices
at Home
Number
Method of Disposal Number
Yes* 15

No 36 Bury 8

No Data 5 Return to Company 4

Total 56 Garbage Can 4

Reuse Container 3

Composting 1

No Data 37
Environmental History: Exposure to
Chemicals
Exposed to
Chemicals at Not Exposed to
No Data
Work or Duting Chemicals
Leisure

Males 4 29 12

Females 6 3 2

Total 10 32 14
Environmental History: Type of
Cooking
Cooking
Number
Type
Wood/Ch
49
arcoal
Gas 2
Electricity 2
Palm
2
Seed Oil
No data 1
Total 56
Environmental History : Source of
Water
Exposure to Pesticides

Sick Number

Yes 17

No 39

Total 56
 Exposure to Pesticides

Symptoms Felt Number

General (fever, headache, chills,

12
weakness)
Respiratory ( diff breathing, chest pain,
9
tightness)
Eye (redness, itchiness, blurring, tearing,
6
dryness)

Musculoskeletal ( myalgia, neck/back pain) 6

ENT (cough, nasal congestion,

5
hoarseness, dry throat)

Dermal (dry skin, itchiness) 2

CVS (palpitation) 2
 Review of Symptoms
Symptoms Felt Number

General (fever, headache, chills, weakness) 17

Musculoskeletal ( myalgia, neck/back pain) 12

Respiratory ( diff breathing, chest pain,

10
tightness)
ENT (cough, nasal congestion, hoarseness,
8
dry throat)

GIT 8

Eye (redness, itchiness, blurring, tearing,

6
dryness)

Genitourinary 4

Others 6
 Physical Exam Findings
• Mean SBP 123.3 (90-160)

• Mean DBP 76.9 (60-100)

• 10 farmers with elevated systolic and/or diastolic BP

• Mean HR 71.6 (48-90)

• 37 normosthenic, 12 underweight, 6 overweight, none obese

 Skin Findings

Finding Number
Hypo/hyper pigmented patches 25

Lichenified lesions 8

Itchy, scaly lesions 3

Thickened waxy dorsum of hands 2

Discolored/deformed/thickened nails 24

Yellow brown discoloration of nails 6

Brittle nails 5

Mee's lines 4

Pale nailbeds 3

Cyanotic nailbeds 1
 ENT Findings

Finding Number

Carious teeth 28

Nasal congestion 9

Impacted cerumen 8

Tonsillopharyngeal Congestion 5

Cervical lymphadenopathy 5

Others 2
 Neurological Findings

Finding Number

Visual Acuity Defects 30

Hearing loss 5

Sensory deficits 2

Weakness in face 1

Postural tremors 1
 Other Findings

System Finding

Wheezing 2
Respiratory
Harsh breath sounds 2

Fleshy scleral growths 4

Eccentric pupil
Ocular Corneal Haziness
Reddish conjunctiva
Lens opacity ex
 Clinical Diagnosis

Diagnosis Number

Fungal infection 41
Skin Chronic Irritant Dermatitis 12
Paronychia 13
EOR 30
EENT Dental Caries 28
Irritant Rhinitis 9

Hearing Loss 5
Neuro
Neuropathy 2

Asthma/Asthma like 4
Respiratory CRLD from PTB 1
Pulmonary Mass 1
 Pulmonary Function Test

• Pulse Oximetry Ave 98.4 (95-99)

• Spirometry Results Freq
Normal 39

Abnormal 17

Restrictive Lung 10

Obstructive Lung 4

Both 1

Small Airway Disease 2

 Urine Paraquat

Results Freq
Not detected 5

Present 46

< 0.18 ng/ml 20

0.19-200 21

201-500 3

>500 2

•ADI: 0.004 mg/kg/day [12]

•MCL: Not Available
•RfD: 0.0045 mg/kg/day [13]
•PEL: Not Available
•HA: 0.03 mg/L (lifetime) [111]
•TLV: 0.1 mg/m3 (8-hour) (respirable fraction)
•a concentration of 100 g/l at 4 hrs indicates a 70% chance of survival but at 20 hrs indicates less than a 10% chance of surviva
 Labs
• Anemia in 2
• Chest X-ray - PTB in 2, pneumonia in 1, atheromatous
aorta in 4, cardiomegaly in 1

• Creatinine > 1.2 in 16

• SGOT >49 in 5, SGPT >49 in 5
 Summary

• Integumentary changes (chronic irritant dermatitis) that could be compatible

with chronic paraquat exposure were seen in 21.4 %; nail changes were seen in
69.6%

• 30.3% had abnormal spirometry findings

• Urine paraquat was detected in 90% of workers, although less than detectable
limit in 43%

• Although majority of workers use PPE, the item used may not provide enough
protection against paraquat
 Recommendations
• Review suitability of PPE
• Review work practices when handling
paraquat

• Strengthen OSH programmes at the

workplace