POVERTY-ENVIRONMENT REPORT: PESTICIDE USE IN THE MEKONG DELTA, VIETNAM

By Craig Meisner, DECRG-IE

I. BACKGROUND
Vietnam began using pesticides as early as the 1950s, when agricultural production was limited to cooperatives, collective farms, and state farm enterprises. Under this regime, little knowledge existed of the hazards of pesticides, and with no regulation system. Application was centrally-run by brigades of 4-5 farmers who worked in conjunction with the Plant Protection Department (PPD). The PPD supplied pesticides at subsidized prices and recommended spraying on a calendar basis, with little or no attention to field conditions. Brigade interventions generally resulted in high costs but had little effect on pests and diseases (Pincus 1995; Chung and Dung, 2000). By 1988, farming units were recognized as autonomous production units giving households the control over all stages of production, including the pesticide use decision. As a consequence of past excess, coupled with a new lease on production, the dependency on pesticides grew and as Figure 1 shows, this growth peaked in 1998 at over 40,000 tons (FAO, 2004).1 Figure 1: Consumption of pesticides, 1990-1999.
45,000 40,000 35,000 30,000 Metric tons 25,000 20,000 15,000 10,000 5,000 0 1991 1992 1993 1994 1995 1996 1997 1998 1999

In addition to the alarming increase in pesticide use, there is also significant evidence suggesting that the substances being used are harmful to human health and the environment. In a nationwide survey conducted by the PPD in 2000, 2,500 kg of banned pesticides were found (methamidophos, DDT and other chemicals), along with 4,753 liters and 5,645 kg of illegally imported or counterfeit pesticides (PPD, 2000). Another survey in August 2000, among 480
1

Since 1986, the pesticide market has been liberalized and there are currently nine state-owned and four privately-owned formulation plants in Vietnam. However, the government is no longer granting licenses for new formulation plants as there is an apparent overcapacity for Vietnam's current needs.

farmers in four provinces in the South, found 96.6% of farmers used pesticides excessively and not in compliance with the instructions on the labels, and nearly 95% of farmers pour residual spray into canals and ditches or reapply on other plants or over-apply on the same crop just to get rid of it (Huan et al., 2000). In regards to the health impacts of pesticide use, hospital admission records in Vietnam trace nearly 11% of all poisonings to pesticide misuse: or approximately 840 poisonings in 53 cities and provinces in 1999 (Poison Control Center, Vietnam Ministry of Health, 2000).2 Given the rather dire picture of pesticide use in Vietnam, two broad questions that this section of the Poverty-Environment Nexus report attempts to answer are: 1) Are the poor using more, toxic pesticides? 2) Is pesticide use, and its attended health consequences, impacting the poor to a greater extent than the non-poor? In developing a response to these questions, the World Bank team constructed detailed pesticide use and medical surveys to be implemented on a representative sample of poor and non-poor farmers in Vietnam. A description of the survey, sample and the results follows.

II. DESCRIPTION OF THE WORLD BANK SURVEY AND SAMPLING STRATEGY

A survey of Vietnamese farmers was carried out by the Research Department of the World Bank in the winter of 2003. Structured questionnaires were used to collect information on farming systems, pesticide use and practices, applicator precautions/ averting behavior and health/ environmental effects. The survey was divided into two major sections, one dealing with the economics of pesticide use (e.g. production, pesticides used, protection, training, etc) and another strictly dealing with the health of the farmer (e.g. questions on self-reported health ailments/ health-related habits, a general physical exam, and patch-skin and blood tests for pesticides). The survey was constructed by the World Bank team in collaboration with the University of Economics in Ho Chi Minh City3 (for the socio-economic portion of the survey) and the Centre of Occupational and Environmental Health (COEH) of the Vietnam Association of Occupational Health (VINOH) for the medical survey. 4 Each of these World Bank counterparts were responsible for the implementation of the survey. To minimize any possible reporting bias, the survey was conducted under the agreement that the team would not reveal the identity of the farms surveyed or the respondents.

Reliable data on the incidence of pesticide poisoning is rare in most countries. At best it is an underestimate because the source of the surveillance data from which these figures are derived is health facilities. These figures represent only a small fraction of pesticide poisoning for a number of reasons. First, only a small number of severe poisonings are present in the health care system. These usually are suicide attempts. The bulk of cases - milder, occupationally related - will not necessarily report to the health care system due to costs, inaccessibility of services, or fear of reporting and loss of employment. Finally, those few farmers that do present themselves for treatment are often misdiagnosed because pesticide poisoning mimics other health problems. Therefore the magnitude of occupational pesticide poisoning is underestimated which makes it difficult to inform policy (FAO, 2001). The World Health Organization estimates that there are 50 cases of poisoning for every case reported and registered, which translates into nearly 375,000 cases each year in developing countries. The estimated number of fatalities from agrochemical exposure are at least 20,000 every year, the majority in developing countries (WHO, 1990; Kishi et al., 1995; Pimental et al., 1992; Rosenstock et al., 1991). 3 The socio-economic portion of the study was headed by Professor Nguyen Huu Dung of the Environmental Economics Unit, University of Economics, Ho Chi Minh City. 4 The medical portion of the survey was headed by Dr. Khuc Xuyen of the Vietnam National Association of Occupational Health (VINOH).

Although the survey was conducted in a single season (the winter of 2003), respondents were asked detailed production and pesticide use questions that spanned the period of one year. Thus the survey contained information for the three major growing seasons of Winter-Spring 20022003, Spring-Summer 2003, and Summer-Autumn 2003.

II A) DEFINITION OF THE POOR

As the primary focus of the study was to investigate the potential inter-linkages of pesticide use and the poor, we adopted the poverty line set by the Ministry of Labor, Invalids, and Social Affairs (MOLISA) Decision No. 1143 (MOLISA, 2001). This poverty line was also re-iterated in the recent Comprehensive Poverty Reduction and Growth Strategy (CPRGS) signed by the government in 2002.5 Applying this criteria to our sample of farmers, Table 1 presents the number of respondents who fell into the category henceforth known as the poor. Table 1: Sample poverty distribution6 Number Percent Poverty classification Poor ( 1,200,000 VND/year) 79 13.1 Non-poor 524 86.9 Total 603 100.0

II B) GEOGRAPHICAL LOCATION OF THE SAMPLE

The main geographical area of interest is the Mekong Delta since it has been identified as the most intensive with respect to production and pesticide use (see Map 1 for details). As a sampling strategy, the team took the following into consideration when selecting candidate districts and communes: 1) identifying areas where the poor versus non-poor comparison would be possible (via the use of the latest poverty map from the World Bank, 2003); 2) areas where rice production is dominant; 3) selection of farms that vary in geographical location (e.g. coastal versus inland farms); and 4) focus on rural areas so as to target the rural poor (as opposed to the urban poor in the cities).

The new poverty line published in 2001 is to be applied to poverty measurement in the 2001-2005 period in which the new national poverty line developed by the National Poverty Reduction Program is defined at different levels depending on specific areas/regions, based on per capita income: VND 80,000 per month for island areas and rural mountainous areas, VND 100,000 per month for rural plain areas, and VND 150,000 per month in urban areas (pg. 17, CPRGS, 2002). 6 The low representation of poor farming households is primarily due to the definition of poor (as 1,200,000 VND/ year); where the majority of farms exceed this poverty line where many of the poor do not own land and thus do not make pesticide decisions (the primary focus of the survey).

Map 1: District location and number of poor/non-poor farms in the survey sample

Note: the low representation of poor farming households is primarily due to the definition of poor (as 1,200,000 VND/ year); where the majority of farms exceed this poverty line since many of the poor do not own land and thus do not make pesticide decisions (the primary focus of the survey).

III. SURVEY RESULTS III A) GENERAL FARMER STATISTICS

Table 2: Farmer characteristics (%).
Ownership Poor Non-poor 5.1 3.8 Own < 100% of land 94.9 96.2 Own 100% of land 100.0 100.0 Total Farm size Poor Non-poor < 0.50 ha 36.7 9.4 0.50-0.99 31.6 26.3 1.00-1.49 20.3 23.7 1.50-1.99 6.3 17.2 2.00-2.49 1.3 8.6 2.50+ 3.8 14.9 Total 100.0 100.0 79 524 Education No schooling Primary Secondary High school Other Total Poor Non-poor 1.3 1.3 54.4 32.1 34.2 45.8 7.6 18.7 2.5 2.1 100.0 100.0 79 524

Sample size (n=)

79

524

A large proportion of the farmers surveyed owned 100% of their land, with 89% of poor and 60% of the non-poor farming less than 1.5 hectares of land. In terms of education, over half of the poor had at least primary education, while a larger percentage of the non-poor had secondary and high school education.

III B) PESTICIDE USE

Pesticide use is generally measured using a variety of key indicators such as number of applications, the absolute amount used, as well as a measure of the relative risk of the pesticide. The absolute measures of pesticide quantity are straightforward in interpretation, however, factoring in the relative risk of each pesticide requires the adoption of a methodology that can rank one pesticide as more toxic than another. The methodology we propose is elaborated below. By simply summing all pesticides (measured as kg of active ingredient) used in crop production, this implicitly assumes that all pesticides are alike in terms of their toxicity. However, it is common knowledge that different substances have different levels of toxicity to both humans and the environment. To do this, we constructed risk-weighted measures by defining risk as the relative toxicity or lethality of each active ingredient. Risk-weighted measures place a greater weight on more toxic substances and provide a more convenient measure of comparing the use of one pesticide over another from a health-hazard perspective. To gauge the relative toxicity of each active ingredient, a measure called the LD50 (or lethal dose 50%) is used. LD50 is a statistical estimate of the number of milligrams (mg) of toxicant per kilogram (kg) of bodyweight required to kill 50% of a large population of test animals. Pesticides with a lower LD50 value are more toxic, thus in the calculations used for this study, each pesticide load was multiplied by 1/LD50 to account for its relative toxicity and giving greater weight to more toxic substances.

Figure 1: Mean pesticide application, risk-weighted amount and number of applications by poor/non-poor (kg).
6.0

5.0

4.0

3.0

2.0

1.0

0.0 Application amount *** Risk-weighted amount (kg) (per 100 kg) No. of applications **

Poor (n=79)

Non-poor (n=524)

*** - difference is statistically significant at the 1% level; ** - difference is statistically significant at the 5% level. Returning to the pesticide use indicators in Figure 1, we see that the mean application amount over the three growing seasons is higher for the non-poor, as well as in terms of the number of applications. However, when we account for the relative risk of the pesticides used, the poor are using more toxic pesticides in absolute terms.7 To better understand the extent of risk exposure, make use of a widely-known categorical method developed by the World Health Organization (WHO) and also based on the LD 50 measure.8 Pesticides are divided into 4 major hazard groups: Category Ia & Ib (extremely hazardous), Category II (moderately hazardous), Category III (slightly hazardous), and Category U (least hazardous or unlikely to present acute hazard under normal use). Field evidence suggests that human poisonings correlate reasonably well with these toxicity ratings (Levine and Davies, 1982). In Table 3, we provide a summation of the total amounts of pesticides under the WHO classification system. Note that over one-half of the pesticides under use in this sample are moderately hazardous. In Figure 2 we see further evidence of the earlier result that the poor are using more toxic pesticides by the higher mean use of WHO Ia & Ib pesticides. Table 3: Total amount pesticides applied by WHO classification Category Total (kg a.i.) Percent Ia (extremely hazardous) 0.0 0.0 Ib (extremely) 5.4 0.5 II (moderately) 594.7 55.5 III (slightly) 187.3 17.5 U (Unlikely) 283.8 26.5 Total 1071.1 100.0

Figure 2: Mean application of WHO Ia & b

7

Mean application amounts on a per hectare basis (both un-weighted and risk-weighted) possess the same pattern where the non-poor applied at a higher per hectare rate and in terms of the risk-weighted measure, the poor registered a higher rate. 8 The WHO toxicity rating is based on the lowest published oral LD 50, typically tested on rats. While WHO ratings generally reflect acute toxicity, they also take into account other toxic effects such as reproductive and developmental toxicity (WHO, 2002).

and common pesticide classes by poor/non-poor9 (kg).

0.14 0.12 0.10

kilograms

0.08 0.06 0.04 0.02 0.00 WHO Ia & Ib Carbamates Organophosphates Pyrethroids *** ***

Poor (n=79)

Non-poor (n=524)

*** - difference is statistically significant at the 1% level; Yet another important method of classifying pesticides is by their chemical class. The chemical class is quite simply a pesticides chemical structure, which will dictate the properties that a pesticide holds. Perhaps the two of the most important properties to human and environmental health are toxicity and degradability. Certain chemical classes have been identified as being highly toxic and persistent in the environment. Epidemiological studies have linked so-called carbamates, organophosphates and pyrethroids with fetal death, hormonal changes, DNA damage, birth defects, and abnormal sperm, ovaries and eggs.10 11 Among the sample farmers in the Mekong Delta, we see a consistent pattern in Figure 2 among the non-poor, where they are using significantly higher average amounts of carbamates, organophosphates and pyrethroids. Once again we note in the first bar of Figure 2 that it is the poor who are using the most toxic pesticides according to the WHO classification system. Thus when setting priorities, one must first select a measure upon which a policy benchmark can be formulated. For example, if one was concerned with banning only WHO Ia & Ib pesticides, then the evidence suggests that focusing on poor farmers may better address this issue than strictly focusing on all farmers in general.

Figure 3: Mean application of insecticides, herbicides,

9

Similarly, on a per hectare basis, the poor applied a higher amount of WHO Ia & b pesticides. Organophosphates as a class of insecticides have been linked with Non-Hodgkins lymphoma, leukemia, and lung cancer. In children, organophosphates have been linked to aplastic anemia, which is the failure of the bone marrow to produce blood cells, and leukemia. Children with asthma may have severe reactions to organophosphates in particular (Zahm et al., 1997). 11 Repeated assaults to the nervous system from cholinesterase inhibitors (organophosphates and carbamates) may lead to chronic polyneuropathies (damage to the brain). There are other groups such as pyrethroids and organochlorines that are suspected to alter hormonal balance and the reproductive system because such effects have been identified in animal populations. Given these potential long-term effects, it is important to monitor the use of these products and to inform those who use them of the potential hazards they may pose (FAO, 2001).
10

fungicides and others by poor/non-poor (kg).

1.20

1.00

0.80

kilograms

0.60

0.40

0.20

0.00 Insecticides *** Herbicides *** Fungicides *** Acaricides Nematicides Bactericides Rodenticides ***

Poor (n=79)

Non-poor (n=524)

*** - difference is statistically significant at the 1% level; Pesticides can also be classified by their intended use, for example, the use of insecticides for insect attacks, herbicides for weeds, and fungicides for the mitigation of plant mildew and root rot. Results of the survey reveal in Figure 3 that the non-poor use insecticides, herbicides and fungicides at a rate more than double that of the poor. These averages also closely coincide with those of other studies of pesticide use in the Mekong Delta, where insecticides dominated the group averages (Dung and Dung, 2000). Figure 4: Misuse of pesticides: Do farmers use any pesticides recommended for other crops, on rice?
Poor (n=79)
I don't know 3.8% Yes 1.3%

Non-poor (n=524)
I don't know 5.3% Yes 4.6%

No 94.9%

No 90.1%

The misuse of pesticides, or using pesticides on a crop for which it is unintended, is not a very common practice among the farmers in the survey; although, nearly 5% of non-poor farmers mentioned misuse of some kind.12 These results also highlight the importance of confirming selfreported information in the field. The overuse of pesticides is also a concern from health and environmental perspectives. In the survey farmers were asked their pesticide dosage rates which were then compared to the recommended dosages on the label. A statistical analysis of the extent of pesticide overuse revealed that the poor have a significantly lower probability of overusing.13 Other variables that contributed to the determination of overuse were farm size, income and the proportion of WHO
12

The non-poor were more likely to misuse pesticides; significantly different at the 5% level of significance.

class II pesticides used in production. Overuse was also found to be more prevalent in the provinces of An Giang and Cantho. Table 4: Perceived risk of pesticides by poor/non-poor. Poor Non-poor Perceived risk High risk 30.4 21.0 Medium risk 25.3 26.3 Small risk 27.8 31.1 No risk 13.9 20.4 Dont know 2.5 1.1 Total 100.0 100.0 Sample size (n=) 79 524 Increasing a farmers awareness of pesticide risk is an important first step in designing any program on safer alternatives, however, do farmers think that the pesticides they are using pose any significant risks to their health and the environment? According to the studys results in Table 4, only 42% of the poor and 52% of the non-poor think the pesticides they are using pose small or no risks. In addition, the low level of uncertainty (Dont know) leads us to believe that a high percentage of farmers regard their pesticide use as hazardous, however, it may be the case that they are unaware of the exact health consequences.

III C) PESTICIDE CONTROL MEASURES AND AVERTING BEHAVIOR

As an alternative to pesticide use, other pest management methods are possible and appear to be gaining traction in Vietnam. The main appeal to alternative methods is that the farmer decreases his/her use of pesticides and it is therefore considered a more safer alternative. Examples of other methods include Integrated Pest Management (IPM: an ecologically-based approach to control of harmful insects and weeds14), biological control (use of natural or modified organisms, genes, or gene products to reduce the effects of pests and diseases), or organic methods (farming that avoids the use of synthetic chemicals and genetically modified organisms (GMOs)). Among the farmers sampled in the Mekong Delta, approximately 32% of the non-poor practice alternative pest control methods and 21% among the poor (Figure 4).15 The most popular control method across both the poor and non-poor is Integrated Pest Management (IPM), then mechanical-physical techniques (such as manual weeding) and biological control measures. The level of adoption appears to be higher for the non-poor leading to a possible explanation that the non-poor may have better access to information and training on alternative methods. This was indeed verified when 54% of the non-poor (versus 37% for the poor) stated that they had received formal training on IPM methods. Thus if the policy goal is to train that segment of the population that is relative more unaware, one could either include more poor people in the program or have a program that targets them solely.
Poor (n=79)

Figure 5: Prevalence of pest control measures by poor/non-poor.

IPM 8.9% Mechanicalphysi cal techni ques 7.6%

Non-poor (n=524)

IPM 15.8%

13

In the (probit) modeling exercise overuse was defined as the dose amount over the label Me chani cal then summed physical across all pesticides used. It was then coded as =1 for positive amounts, 0 otherwise. te chniques Biol ogical 14 8.8% control IPM uses better knowledge of local conditions to maintain yields while reducing chemical inputs. IPM 3.4% Biological relies on natural parasites and predators to control pest populations whenever possible. Farmers in many O ther control Do not Do not use developing countries have used IPM to 0.4% chemical pesticideuse by limiting applications to areas where cut use 4.7% pest control pest control natural controls are insufficient. 78.9% 68.2% O rganic O the r 15 production This difference is statistically significant at the 1% level of significance. 2.0% 0.4%
Rotation of crop 0.4%

Rotation of crop 0.1%

O rgani c producti on 0.4%

The education of farmers on safer alternatives is one piece of a two-part initiative on raising awareness and improving farmer productivity. The second part is to increase education on the safe handling and application of pesticides. As was earlier discussed, even simple knowledge of the relative toxicity may induce the farmer to take remedial or more protective actions in the shortterm. From our survey evidence, in Figure 6 we see that only about 29% of the poor and 34% of the non-poor had any formal training on pesticide safety. This difference was not significantly different leading us to believe that the poor have the same access to information as the non-poor. Figure 6: Prevalence of basic training on safe handling and application of pesticides by poor/non-poor.
Poor (n=79) Non-poor (n=524)

No 70.9%

Yes 29.1%

No 65.8%

Yes 34.2%

The potential suppliers of pesticide information may enter at different stages of the pesticide use decision. As mentioned above, one stage may be ex-post, or after the farmer has chosen what to use and is now learning more about the pesticide they were using in the past. Another is at the purchasing stage or retailer level. When purchasing pesticides, farmers may also have the opportunity to learn more about the pesticide through pamphlets, brochures and other media. This information may influence the pesticide decision and would be particularly helpful to the farmer in terms of understanding what is needed to adequately prepare for the application (e.g. how much to apply, what the pesticide can be used for or on, what protective measures are necessary for avoiding exposure, etc). Among the sample of farmers in this study, only 42% of the non-poor reported receiving safety information and procedures on pesticide use versus only 39% for poor farmers. Of the farmers who received information, the main source of the information was from the public media, pesticide companies and agricultural officials (Table 5). The significant role of the public media for the poor

clearly indicates an opportunity for extension agents and local community groups to foster greater communication and awareness among poorer farmers in the region. Table 5: Main sources of pesticide information by poor/non-poor (%). Source Poor Non-poor Public media 38.8 40.9 Pesticide companies 17.8 18.5 Other 14.4 12.8 Agricultural official 17.7 11.6 Pesticide retailer 5.5 9.1 No information available 5.5 7.1 NGO 0.2 0.1 Total 100.0 100.0 Sample size (n=) 79 524 In addition to formal training and access to information on the health risks posed by pesticides, protection habits are probably one of the most effective short-term measures that a farmer may take to better ensure safety. In the survey, farmers were asked about the protective clothing they wear during pesticide application. As Figure 7 shows, a high percentage of farmers use basic protective measures such as shirts, and trousers, and about half use hats and masks, even among the poor. However, with respect to increased protective measures such as gloves, glasses and shoes, the average falls, especially among the poor. 16 Figure 7: Use of protective clothing while using pesticides (%).
100 90 80 70

Percentage

60 50 40 30 20 10 0 Shirt Trousers Mask Hat Gloves Glasses Shoes

Poor (n=79)

Non-poor (n=524)

When asked as to the reason why they did not use the protective measure, the most common response for glasses, masks, shirts, trousers and gloves was that the item was uncomfortable, which is often the case when the farmer gets overheated during the day (Table 6). In the case of shoes, those who did not wear them felt that they were inappropriate, which may be the case for paddy rice. The poor also consistently stated a higher percentage of unavailable items across all clothing, and especially for hats and glasses. Table 6: Stated reasons for not wearing the protective clothing measure
16

Non-poor farmers use more protective measures and this is statistically significant at the 10% level.

by poor/non-poor (%).
Reasons Not available Uncomfortable Inappropriate Unnecessary Other Total Sample size (n=) Shoes NonPoor poor 19.3 16.5 16.9 23.8 48.2 42.6 12.0 10.1 3.6 6.9 100.0 100.0 79 524 Hat Glasses Mask Shirt Trousers Gloves NonNonNonNonNonNonPoor Poor Poor Poor Poor Poor poor poor poor poor poor poor 51.2 40.7 32.9 25.2 16.2 16.2 0.0 5.0 0.0 0.0 19.2 17.8 31.7 39.6 34.2 41.4 54.1 52.5 100.0 45.0 80.0 68.0 41.1 45.4 2.4 7.0 12.3 12.7 10.8 10.8 0.0 20.0 0.0 4.0 13.7 13.0 12.2 8.5 16.4 16.4 13.5 12.3 0.0 20.0 0.0 8.0 19.2 19.1 2.4 4.1 4.1 4.2 5.4 8.3 0.0 10.0 20.0 20.0 6.8 4.7 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 79 524 79 524 79 524 79 524 79 524 79 524

III D) HEALTH
The health consequences of pesticide use were recorded during the survey. Two types of data were collected, farmer self-reported and medical test data. Self-reported data is often collected in the absence of full medical test data, as test data may be either cost or time prohibitive. In this study we opted to collect both self-reported and medical test data to facilitate a comparison between the two and to test the reliability of farmer self reporting. It should be noted that the medical survey covered only 482 out of the 603 farmers from the socio-economic survey. The remainder of these were unreachable at the time of the medical survey. Among the various self-reported health impairments after using pesticides, a high percentage of both the poor and non-poor experienced acute (or short-term) health effects such as skin irritations, headaches, dizziness, eye irritations and shortness of breath (Figure 8). Upon asking the farmers whether they believed that these symptoms were related to pesticide use, 81% of poor and 82% of non-poor farmers believed this to be true. Figure 8: Self-reported health impairments after using pesticides (%).
70 60 50

Percentage

40 30 20 10 0 Skin irritation Headache Dizziness Eye irritation Other problems Shortness of breath Fever Vomiting Convulsions Diarrhea

Poor (n=70)

Non-poor (n=412)

To further confirm the evidence of the extent of pesticide-related health problems, a team of medical doctors17 were deployed to screen and test farmers for pesticide exposure. An initial screening was conducted using several key indicators that are important in the identification of
17

Medical doctors from the Centre of Occupational and Environmental Health (COEH) of the Vietnam Association of Occupational Health (VINOH), Hanoi, Vietnam.

potential pesticide exposure prevalence of skin diseases, blood pressure, respiratory ailments and heart disease. Tests revealed a fairly high prevalence of skin diseases among all farmers (28-33%), with the poor showing a higher symptomatic rate for each of skin disease (other dermatose), heart disease, respiratory ailments and blood pressure (Table 7). Table 7: Medical examination results for common problems relating to pesticide use by poor/non-poor (%).
Skin Poor Normal Irritant Allergic Other 32.9 dermatose Total 100.0 Sample size 70 Nonpoor 58.6 60.2 2.9 4.6 5.7 6.8 28.4 100.0 412 100.0 70 100.0 412 100.0 70 100.0 412 100.0 100.0 70 412 Blood Normal Low High Poor Nonpoor 80.0 89.3 5.7 2.4 14.3 8.3 Respiratory Normal Pneumonia Bronchitis Poor Non- Heart poor 95.7 98.3 Normal 0.0 0.2 Positive 4.3 1.5 Poor Nonpoor 98.6 99.3 1.4 0.7

Skin test: Poor (n=60) of commonly Positive reaction 38.3%

Figure 9: Medical skin tests for the detection and reactivity used pesticides, by poor/non-poor (%). Skin test: Non-poor (n=153)
Positive reaction 31.4%

Normal 61.7%

Normal 68.6%

100 90 80 70

7 8

7 10

8 17

8 13

10 13

6 16

Percentage

60 50 40 30 20 10 0 Poor (n=60) Non-poor (n=153) Poor (n=60) Non-poor (n=153) Poor (n=60) Non-poor (n=153) 85 84 75 79 77 78

Karate

Basudin

Padan

Weak re action

Strong reaction

Extreme reaction

Building upon the initial screening exam, detailed patch-skin tests18 were conducted on the sample of farmers to gauge dermal (skin) exposure to pesticides. Results show that approximately 38% of the poor and 31% of the non-poor registered a positive reaction (Figure 10: top).19 A second stage of skin testing resumed with three of the most commonly used pesticides in the region, Karate (WHO category II), Basudin (WHO II) and Padan (WHO II).20 Test results in the bottom of Figure 9 show that on average 15-25% of farmers experienced a strong to extreme reaction to these pesticides implying that exposure, from a dermal perspective, is significant among those farmers tested. Only small differences in positive reaction were observed between the poor and non-poor, with the largest being for Basudin (organophosphate) at 4%.
18

Selection criteria included the symptoms of contact dermatitis, such as skin itch, prurigo, skin irritation, and allergy. The purpose of the test was to diagnose farmers suffering from some form of pesticide contact dermatitis (irritant contact dermatitis and allergic contact dermatitis). 19 A statistical analysis of blood test results revealed that there was no significant difference in mean pesticide poisoning for poor and non-poor. A further regression analysis of blood test results revealed that the key determinants of poisoning were pesticide amount, the proportion of WHO class Ia and Ib pesticides used in production and the number of protection measures taken. The prevalence of blood poisoning was also found to be higher in the provinces of Cantho and Tien Giang. 20 Karate 2,5 EC: Pyrethroid, Basudin 50 EC: Organophosphate and Padan 50 SP: Carbamate.

Figure 10: Medical blood tests for the detection of acute and chronic pesticide poisoning, by poor/non-poor (%).
Blood test: Poor (n=59) Blood test: Non-poor (n=129)
Poisoning 32.6%

Poisoning 42.4%

Normal 57.6%

Normal 67.4%

Severity of poisoning Acute poisoning Chronic poisoning Total Sample size

Poor 40.0 60.0 100.0 25

Non-poor 42.9 57.1 100.0 42

A third stage of pesticide exposure testing resumed with detailed blood tests.21 Results indicate (Figure 10: top) that the poor experience a higher prevalence rate of blood poisoning than nonpoor (42% versus 33%). Among those who tested positive for blood poisoning (25 poor, 42 nonpoor ), fifteen or 60% of the poisoned poor were found to be chronic cases, and 24 or 57% of non-poor (Figure 10: bottom table).

IV. CONCLUSION AND DISCUSSION

Pesticide use has been on the rise in Vietnam, notably over the past decade with a near doubling of consumption from 1990-1998. Field evidence has suggested that farmers are also misusing and overusing pesticides in order to maintain crop yields and production. As a consequence of this growing dependence and hap-hazard use of pesticides, the prevalence of health impairments and environmental damage are mounting. The purpose of this component of the Poverty-Environment Nexus study is to answer two questions relating to pesticide use in Vietnam, 1) Are the poor using more, toxic pesticides?, and 2) Is pesticide use, and its attended health consequences, impacting the poor to a greater extent than the non-poor? A World Bank survey of 603 farmers was conducted in the Mekong Delta, Vietnam, an area known for extremely intensive agriculture. The survey comprised two major sections, one to gather information on crop production and related pesticide use by farmers, and one on the health and medical condition of the farmer. In regards to the first major question, survey results indicate that although the poor are currently using smaller amounts of pesticides (as well as on a per hectare basis), they are using relatively more toxic pesticides. Several toxicity indicators were constructed to measure a pesticides degree of relative toxicity. By weighting a pesticides active ingredient by its degree of lethality (or
21

The test was a cholinesterase enzyme technique measuring active cholinesterase enzymes in erythrocyte and plasma using the Test-Mate-Kit (EQMR-USA), with 0.03ml of blood from the fingertip. The purpose of this test was to aid in the diagnosis and detection of persons suffering from pesticide poisoning (organicphosphates and carbamates).

by the LD50 value) and categorizing this measure according to the WHO risk classification system, the poor are using a greater percentage of WHO Ia & Ib pesticides. Analogously, by classifying pesticide use by its chemical class, it was found that the non-poor are using a greater amount of carbamates, organophosphates, and pyrethroids. In regards to the second question, farmer self-reported and medical test data were compiled and compared. A large proportion (40-60%) of poor and non-poor farmers reported episodes of skin irritation, headaches, dizziness, eye irritation and shortness of breath after using pesticides. Upon closer examination by medical doctors, although few were suffering from heart disease, respiratory ailments or large abnormalities in blood pressure, approximately 33% of the poor and 28% of the non-poor experience some type of skin disease (under the classification other dermatose). Patch-skin tests for external pesticide exposure revealed that approximately 38% of the poor and 31% of the non-poor farmers reacted positively to the presence of pesticides. Blood tests for internal pesticide poisoning showed that the poor (25 out of 59 or 42%) had a slightly higher prevalence rate than the non-poor (24 out of 153 or 32%), however this difference was not statistically significant.

V. REFERENCES
Comprehensive Poverty Reduction and Growth Strategy (CPRGS), 2002. Document No. 2685NPCP-QHQT, Hanoi, Vietnam. Chung, D. K. and K. T. Dung. 2002. Pest Management in Rice Production in Vietnam: A Socioeconomic Assessment. Hanoi: Nha Xuat Ban Nong Nghiep. Dung, N. H. and T. T. T. Dung, 1999. Economic and Health Consequences of Pesticide Use in Paddy Production in the Mekong Delta, Vietnam. EEPSEA Research Report No.1, pp. 1-39. Available at: http://www.eepsea.org/en/ev-8427-201-1-DO_TOPIC.html. FAO, 2001. Farmer Self-Surveillance of Pesticide Poisoning Episodes: Report on One Month Pilot: August 15-Sept 15, 2000. FAO Programme for Community IPM in Asia, Field Document. FAO, 2004. FAO-STAT. http://apps.fao.org/default.jsp. Statistics downloaded for Vietnam. Available at:

Kishi, M., N. Hirschhorn, M. Qjajadisastra, L. N. Satterlee, S. Strowman and R. Dilts, 1995. Relationship of Pesticide Spraying to Signs and Symptoms in Indonesian Farmers, Scandinavian Journal of Work & Environmental Health, 21: 124-133. Levine, R.S., and J.E. Davies, 1982. Pesticide Toxicity and Mode of Action. In J.E. Davies, V.H. Freed, and F.W.Whittemore (eds.), An Agromedical Approach to Pesticide Management: Some Health and Environmental Considerations. Miami, Fla., USA: University of Miami School of Medicine in cooperation with the Agency for International Development (USAID) and Consortium of International Crop Protection. Nguyen Huu Huan, Le Van Thiet et al., 2000. Results of survey for confidence, attitude and practices in safe and effective use of pesticides. Pimental, D., Acquay H., Biltonen, M., 1992. Environmental and Economic Costs of Pesticide Use. Bioscience, 42, 750-60. Pincus, J. 1995. Pesticide Policy Survey. Unfinished report. FAO Intercountry Programme for IPM in Rice in South and Southeast Asia, Hanoi.

PPD (Plant Protection Department), 2000, Report on Results of Nation-wide Inspection of Pesticide Regulation Enforcement in 2000, Large-scale Inspection Meeting for 2000 in Hanoi, 31 October 2000. Rosenstock, L., Keifer, M., Daniel W.E. et al, 1991. Chronic Central Nervous System Effects of Acute Organophosphate Pesticide Intoxication. Lancet, 338, 223-7. World Health Organization (WHO), 1990. Public Health Impact of Pesticides Used in Agriculture, 1990. WHO (World Health Organization), 2002. The WHO Recommended Classification of Pesticides by Hazard and Guidelines to Classification 2000-2002, Geneva, World Health Organization. Available at: http://www.who.int/ipcs/publications/pesticides_hazard/en/ World Bank, 2003. Poverty Map for Vietnam. World Bank and the General Statistics Office, Vietnam. Zahm, S. H., M. H. Ward and A. Blair, 1997. Pesticides and Cancer. In: Occupational Medicine: State of the Art Reviews. Vol. 12: Pesticides (Keifer, M., ed). Philadelphia: Hanley and Belfus, Inc., p.269-289.

Appendix: Supporting regression work Overuse regression Variable Coefficient 0.001 age 0.018 educ 0.000 owner t-ratio 0.27 0.26 0.05

farmsize income prsppoor ptrain pwhoI pwhoII pwhoIII AnGiang Cantho LongAn TienGiag Constant N LR Log likelihood

0.079* 0.000* -0.379** -0.072 -0.009 0.012*** 0.001 0.289* 0.670*** -0.074 -0.006 -1.207** 603 54.880 -384.52

1.94 1.64 -2.11 -0.63 -0.61 3.18 0.37 1.64 3.71 -0.42 -0.03 -1.99

Variable pestamt pwhoIab pwhoII pwhoIII pwhoU ptrain nprotect ipmd prsppoor AnGiang Cantho LongAn TienGiag Constant

Blood test regression Coefficient -0.087* 0.038** 0.002 0.008 0.006 0.261 -0.421* 0.097 0.203 -0.139 -0.844*** -0.467 -0.846*** -0.144 187 28.650 -108.992

t-ratio -1.89 2.36 0.38 1.21 0.89 1.21 -1.76 0.42 0.87 -0.39 -2.55 -1.41 -2.59 -0.22

N LR Log likelihood