Abstract

The effect of pesticide use on human health is a problem that has received attention from the scientific community worldwide, especially in central countries, where the highest number of deaths due to human exposure to these agents is observed. Production and productivity increased through the progress of agro-industrialization, but risks to the environment and health were not taken into account. Over time, several cases of environmental contamination and public health problems, poisoning of rural workers, and food residues were observed. These factors triggered the recognition of risks arising from pesticide abuse. This study aimed to characterize pesticide poisonings reported to a toxicological information center of the state of Goiás through a retrospective analysis from 2005 to 2015. Data were mapped and tabulated by the purpose of pesticides, the circumstance of poisoning, and case development. The poisoning profile pointed to a higher occurrence of work- and suicide-related poisonings, with a predominance of poisoned patients, although chronic effects were not recorded, suggesting a false diagnosis of cure.

Key words
Poisoning; Agrochemicals; Geographic mapping; Information systems; Compulsory notification

Introduction

Pest and disease control chemical substances were recorded in Greek and Roman writings more than 3,000 years ago¹1 Alves Filho JP. Uso de agrotóxicos no Brasil - controle social e interesses corporativos. São Paulo: Annablume, Fapesp; 2002.. In Brazil, pesticides were introduced and organized, accompanied by technological packages that implanted large-scale mechanization, associated with other production factors through state financing pre-established expenditure (30% of the financing should be spent on insecticides, and 20% on herbicides). Thus, the objective was to promote territory upgrade through field modernization (agroindustrialization), to ensure higher production and productivity, without considering risks to the environment and health.

Several cases of environmental contamination and public health problems, poisoning of rural workers, and food residues have been observed over time. These factors triggered the recognition of the risks arising from pesticide abuse¹1 Alves Filho JP. Uso de agrotóxicos no Brasil - controle social e interesses corporativos. São Paulo: Annablume, Fapesp; 2002.

2 Nunes MV, Tajara EH. Efeitos Tardios dos Praguicidas Organoclorados no Homem. Rev Saúde Pública 1998; 32(4):372-382.

3 Sobreira AEG, Adissi PJ. Agrotóxicos: Falsas Premissas e Debates. Cien Saude Colet 2003; 8(4):985-990.

4 Souza GS, Costa CAC, Maciel AC, Reis FDV, Pamplona YAP. Presença de agrotóxicos na atmosfera e risco à saúde humana: uma discussão para a Vigilância em Saúde Ambiental. Cien Saude Colet 2017; 22(10):3269-3280.

5 Neves PDM, Bellini M. Intoxicações por agrotóxicos na mesorregião norte central paranaense, Brasil - 2002 a 2011. Cien Saude Colet 2013; 18(11):3147-3156.^-66 Espíndola MMM, Souza CDF. Trabalhador Rural: O agrotóxico e sua influência na saúde humana. Rev Uni Vale Rio Verde 2017; 15(2):871-880.. The effect of pesticide use on human health is a problem that has caught the attention of the scientific community worldwide, especially in emerging countries, where the highest number of deaths resulting from human exposure to these agents is observed⁷7 Silva AM, Alves SMF. Análise dos registros de intoxicação por agrotóxicos em Goiás, no período de 2001 a 2004. Rev Eletr Farmácia 2007; 4(2):194-201., because technological packages continue to be imposed, without considering the edaphoclimatic conditions, the historical land, water use processes, and people’s know-how.

According to Alves Filho¹1 Alves Filho JP. Uso de agrotóxicos no Brasil - controle social e interesses corporativos. São Paulo: Annablume, Fapesp; 2002., the growing number of issues related to agricultural pesticide use led to the enactment of the Law of Pesticides in 1989, by the Ministry of Health (MS), the Ministry of Agriculture, Livestock and Supply (MAPA), and the Brazilian Institute of Environment and Renewable Natural Resources (IBAMA). Before that (1980), the National Pharmaco-Toxicological Information System (SINITOX) was created, serving as a database of different poisonings. The Pesticide Notification Form was included in the Notifiable Diseases Information System (SINAN) in 1996, merging notification and assistance with the toxicological information control system for the investigation of pesticide accidents. This monitoring aims to expose the situation of pesticide poisoning and delimit fields of action in order to curb the number of accidents⁸8 Ministério da Saúde (MS). Secretaria da Vigilância em Saúde. Agrotóxicos na ótica do Sistema Único de Saúde. Brasília: MS; 2016..

The National Health Surveillance Agency (ANVISA)⁹9 Agência Nacional de Vigilância Sanitária (ANVISA). A regulação e o mercado de agrotóxicos no Brasil. Brasília: ANVISA; 2012. identified that the Brazilian pesticide market had grown 190% in ten years (2000-2010), against a world market increase of 93% in that same period.

If, on the one hand, the agronomic efficiency of pesticides is perceived, since the user can observe it in the fields or in the urban environment where the chemical compound has been applied and verify its expected action and described on the labels, on the other hand, an issue related to the risk that such products cause to the health of human beings and the impact/destruction they cause in the environment is noted. The action of pesticides generally fails to be selective to the point of removing only what is intended, and, in most cases, extermination occurs in several other classes of fauna and flora components existing at the application site¹⁰10 Arruda TF. Agrotóxicos e Sistema Penal [dissertação]. Maringá: Universidade Estadual de Maringá; 2008..

According to studies by Nishiyama¹¹11 Nishiyama P. Utilização de agrotóxicos em áreas de reforma agrária no estado do Paraná. [tese]. Campinas: Universidade Estadual de Campinas; 2003., pesticides can cause undesirable effects on health and nature because of their high biological activity and persistence in the environment. Their improper handling can result in acute poisonings and, sometimes, long-term, exposure-related effects (chronic poisonings).

In this sense, the declining number of bees due to the excessive use of pesticides and their consequences for the reproduction of flowers has long been discussed, as bees assist in the pollination process, directly influencing flower reproduction aspects¹⁰10 Arruda TF. Agrotóxicos e Sistema Penal [dissertação]. Maringá: Universidade Estadual de Maringá; 2008.. Concerning the effects of these products on human health, when studying the Municipality of Lucas do Rio Verde (MT), Professor Wanderlei Pignati (UFMT), Jorge Machado and James Cabral found alarming pesticide contamination rates, even affecting the maternal milk of women in the municipality, emphasizing that none of them worked directly in agriculture¹²12 Pignati WA, Machado JMH, Cabral JF. Acidente rural ampliado: o caso das “chuvas” de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT. Cien Saude Colet 2007; 12(1):105-114..

Some studies report that farmers do not use Personal Protective Equipment (PPE), as in Nova Friburgo (RJ)¹³13 Araújo AJ, Lima JS, Moreira JC, Jacob SC, Soares MO, Monteiro MCM, Amaral AM, Kubota A, Meyer A, Cosenza CAN, Neves CN, Markowitz S. Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 2007; 12(1):115-130., showing that around 70% of respondents do not wear this equipment, further facilitating farmer/worker poisoning. We should point out that PPEs are not comfortable equipment, they are hot (with use mostly in an external environment subject to solar radiation, therefore hot) and non-malleable, hindering manual activities. Thus, these individuals resist and reject its use.

Contrary to what happens with acute poisoning, it is challenging to establish the cause and effect relationships for chronic poisonings, that is, for the morbid manifestations that appear months or years after the continued and frequent exposure to small doses of pesticides. The situation is made even more complex by a large number of commercial brands with different active principles, which are not familiar to doctors. In these cases, doctors should rely on the services of a Toxicological Information Center (CIT), which responds quickly about the chemical composition of a product pointed as responsible for the case and provides specifications for diagnosis, indications about antidotes or other medications and prognosis.

In the State of Goiás, CIT-GO is located in the Superintendency of Health Surveillance (SUVISA) and was founded in 1986, out of the need to have a specialized service capable of providing information related to toxic agents in the environment. The CIT-GO On Duty Service promotes some direction for patient care, thereby reducing their vulnerability and the fragility of the health system in the face of suspected poisoning cases. However, the points of the health care network with referrals to mental health and social services require better articulation, for example, when the poisoning is due to attempted suicide or child contamination, given that nowadays the clinical conduct protocol provides for post-service only through telephone calls to ascertain the condition development of the intoxicated individual, the dosage and the effects of the prescribed medications, and the improvement of the subject’s clinical condition.

The poisoning records of CIT-GO, located at the Superintendency of Health Surveillance (SUVISA), in Goiânia (GO), are transmitted through electronic spreadsheets to SINITOX, which stores and makes information available in a directory. Municipalities also forward notification forms to CIT-GO and are responsible for making such poisoning information available to SINITOX. However, these forms generally take time to be passed on or are sometimes not digitized, due to the limited municipal structure, the lack of staff, and mainly lack of political interest, since most of them are hegemonized by agribusiness.

That said, the best way to analyze the poisoning cases of a state or municipality within this federative unit is looking for the poisoning notification forms stored in the Toxicological Information Center within the Superintendencies of Health Surveillance of each federative unit of the country, as SINITOX guides on its website, and through SINAN. Like SINITOX, SINAN is mainly fed by the municipal health secretariats. As it also advises on its website, the Individual Notification Form must be completed by the care units for each patient when suspecting a notifiable health problem or a problem of national, state, or municipal interest.

Notably, these services are excellent notification systems for the health problems of the Brazilian population. However, they are fed by municipal or state secretariats, by professionals overloaded with several other functions that are unable to feed the database with the necessary agility, taking into account that data from SINITOX and SINAN are not always updated to the current year.

This fact becomes important to understand the reasons that lead to underreporting in pesticide contamination cases, since the number of poisonings we will present tends to be much higher, considering information from the National Council of Health Secretariats¹⁴14 Conselho Nacional de Secretários de Saúde (CONASS). Vigilância em saúde. Coleção Progestores - Para entender a gestão do SUS, 6, I. Brasília: CONASS; 2007., underreporting in these cases is around 1 to 50, that is, 50 unreported cases for each notified case. Notwithstanding this, the available data are alarming.

In the meantime, data was collected through technical visits to the CIT-GO Library as a methodology, with access authorized by the State Health Secretary of Goiás. The exogenous agricultural poisoning notification forms from 2005 to 2015 were cataloged. It should be noted that the records for 2016 and 2017 were not yet available due to complaint or report receipt and handling operational procedures.

All available forms were tabulated based on existing data, such as, for example, municipalities and month of poisoning, type of poisoning agent, circumstance, and the pesticide that caused the poisoning and case development. Based on these systematized data, the second stage consisted of preparing distribution maps of poisoning and agricultural production cases, based on the State Geoinformation System of Goiás (SIEG) and shapefiles. The software used in the elaboration of the maps was ArcGis, allowing the spatialization and distribution of poisoning cases by agricultural pesticides in the state of Goiás.

We also emphasize the importance of Larissa Mies Bombardi’s works in “Small Cartographic Essay on pesticide use in Brazil”¹⁵15 Bombardi LM. Pequeno Ensaio Cartográfico sore o Uso de Agrotóxicos no Brasil. São Paulo: Laboratório de Geografia Agrária USP/Blurb (Ebook); 2016. and “Geography of pesticide use in Brazil and Linkages with the European Union”¹⁶16 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017. in the spatialization and discussion of pesticides in Brazil.

Map of poisonings by agricultural pesticide in the state of Goiás (2005 to 2015)

With the data collection carried out at the CIT-GO Library through records of notifications of exogenous agricultural poisonings from 2005 to 2015, we developed the Map of Poisonings by Agricultural Pesticide in Goiás, from 2005 to 2015 (Figure 1).

This map allowed us to identify the regions of the State with a higher concentration of poisoning cases, to understand the event behind the statements and actions that made Goiás the Brazilian agricultural granary. It highlights that the greater number of pesticide poisoning notifications in areas territorialized by agribusiness, allowing us to establish the agribusiness/pesticide ratio, which, due to the number of pesticides used in large commodity crops, makes these areas champions of harm to the environment and living beings.

In total, 2,987 poisonings were recorded, with the highest incidence found in some municipalities such as Jataí/GO (304 poisonings), Goiânia/GO (249), Rio Verde/GO (157), Anápolis/GO (155), Formosa/GO (114), Acreúna/GO (106), Goiatuba/GO (104), Aparecida de Goiânia/GO (64), Mineiros/GO (56) and Montividiu/GO (46).

It is necessary to consider that these data may be camouflaged because the size of the population of a municipality can interfere with the number of poisonings. Thus, making the relationship between the number of poisoning notifications by the population estimate of the municipalities, as per the IBGE¹⁷17 Instituto Brasileiro de Geografia e Estatística (IBGE). Estimativas populacionais para municípios e para as Unidades da Federação brasileiras em 2015 [página na Internet]. Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/estimativa2015/estimativa_dou.shtm
http://www.ibge.gov.br/home/estatistica/... , we have the information in Table 1.

Table 1 shows us that Goiânia/GO is not one of the municipalities with the highest rates of poisoned people when related to the number of inhabitants. Among the municipalities with the highest number of poisoned people are Aporé/GO, with one poisoning for every 163 inhabitants, Acreúna/GO, with one poisoning for every 205 inhabitants, Montividiu/GO, with one poisoning for every 263 inhabitants, Jataí/GO, with one poisoning for every 3,195 inhabitants, Goiatuba/GO, with one poisoning for every 328 inhabitants, and Paraúna, with one poisoning for every 329 inhabitants.

That said, in order to avoid data concealment due to disproportion, the information contained in the map (Figure 2) refers to poisoning notification cases per pesticide per inhabitant of each municipality.

We can infer, looking at Figure 2, that the Goiás Southwestern Micro-Region recorded the highest amount of poisoning notifications per inhabitant, justified by the high incidence of agricultural monocultures such as soy, corn and sugar cane, which together were the three sectors that most consume pesticides in Brazil, with about 65% of pesticides sold in the country, according to Theisen¹⁸18 Theisen G. O Mercado de agroquímicos [apresentação na Internet]. 2010. Disponível em: http://www.cnpsa.embrapa.br/met/images/arquivos/15MET/mercadoagroquimico.pdf
http://www.cnpsa.embrapa.br/met/images/a... and SINDAG¹⁹19 Sindicato Nacional das Indústrias de Defensivos Agrícolas (SINDAG). Dados de produção e consumo de agrotóxicos [página na Internet]. 2011. Disponível em: www.sindag.com.br
www.sindag.com.br... .

Types of poisoning agents

Pesticides can be classified by the pest to be controlled (insecticides, herbicides, fungicides, among others), chemical group (organophosphates, carbamates, organochlorines, pyrethroids, bipyridyls, mercurials, among others), acute toxicity (class I, II, III, IV - as per LD50) and the ability to trigger the development of cancer in humans (carcinogenesis). In this sense, as per the classification of the International Agency for Research on Cancer (IARC)²⁰20 Agência Internacional de Pesquisa em Câncer (IARC). Monographs on the Evaluation of Carcinogenic Risks to Humans [página na Internet]. 2010. Disponível em: http://monographs.iarc.fr/ENG/Classification/
http://monographs.iarc.fr/ENG/Classifica... linked to the World Health Organization (WHO), several chemical substances, including pesticides, can be classified into 1 - Carcinogenic to humans, 2A - Probably carcinogenic to humans, 2B - Possibly carcinogenic to humans, 3 - Not classifiable as to its carcinogenicity to humans, and 4 - Probably not carcinogenic to humans; and the type of formulation (solvents, adherents, humectants, among others) or presentation (liquid, powder or granulated).

Insecticides are intended for the control of crop-damaging insects, or insects that are part of the epidemiological chain of infectious diseases. Herbicides, on the other hand, are substances designed to control weeds that hinder the development of crops. Moreover, finally, fungicides are substances designed to combat fungi that attack mainly winter crops²¹21 Carneiro FF, Rigotto RM, Augusto LGS, Friedrich K, Búrigo AC, organizadores. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio/FIOCRUZ; São Paulo: Expressão Popular; 2015..

Table 2 shows a higher incidence of herbicides and insecticides used in Goiás and a minimal occurrence of fungicides.

An increased number of herbicide poisoning notifications is observed from 2005 to 2015, and, consequently, a greater use of this type of pesticide may have occurred. According to a study available in the “ABRASCO Dossier: a warning about the impacts of pesticides on health”²¹21 Carneiro FF, Rigotto RM, Augusto LGS, Friedrich K, Búrigo AC, organizadores. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio/FIOCRUZ; São Paulo: Expressão Popular; 2015., the introduction of transgenics in Brazilian crops, reaching about 50% of the 74 million hectares cultivated in Brazil²²22 Instituto Brasileiro de Geografia e Estatísticas (IBGE). Censo Agropecuário 2006. Brasília/Rio de Janeiro: IBGE; 2010. and are herbicide-tolerant, caused an elevated use of this pesticide.

As per the same document²¹21 Carneiro FF, Rigotto RM, Augusto LGS, Friedrich K, Búrigo AC, organizadores. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio/FIOCRUZ; São Paulo: Expressão Popular; 2015., 93% of the cultivated area of corn, soybeans, and cotton are of transgenic seeds, whereas sugarcane did not have transgenic varieties until 2016. However, the National Technical Commission of Biosafety (CTNBio) approved the planting of transgenic sugarcane in June. Thus, herbicide use and consequent poisoning tend to increase, requiring more in-depth monitoring and research.

The descriptions in the investigated forms reveal an incidence of products that were ignored in these compulsory notifications. Possibly, the erroneous completion is due to the unpreparedness and lack of knowledge of the professionals assigned to this task, and also people’s unawareness concerning the pesticides that come into contact with them daily. This requires the immediate training of civil servants who address the subject so that they pay attention to the health problems caused by these toxic products, and, thus, resort to the health authorities, which should adopt appropriate intervention measures. On the other hand, we should value massive educational campaigns for consumers and workers handling these products, such as storage, product dilution, handling, use of personal protective equipment, among others.

Data on pesticide poisoning notifications evidenced a higher number of notifications in men compared to women (mainly in occupational notifications), and this is because pesticides are applied predominantly by male workers.

Circumstance of poisoning

Exposure to pesticides occurs from contact with skin, mucous membranes, breathing, or even the ingestion of pesticides or intoxicated foods, as in several cases presented by the Dossier ABRASCO²¹21 Carneiro FF, Rigotto RM, Augusto LGS, Friedrich K, Búrigo AC, organizadores. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: Escola Politécnica de Saúde Joaquim Venâncio/FIOCRUZ; São Paulo: Expressão Popular; 2015. on the impacts of pesticides on health. Poisoning may be occupational, accidental, or intentional (attempted suicide or homicide).

Occupational exposure refers to professional groups that have contact with pesticides. For the cases presented in the poisoning notification forms at CIT-GO, we have farmers, employees of rural companies, and even endemic disease workers, such as the professionals spraying poison to fight against Aedes aegypti. Such exposure can occur during dilution, the preparation of the syrup, the application of pesticides, and also due to the entry into the fields after the application of the products. In aerial applications, agricultural pilots and their assistants are also considered a risk group.

Sobreira and Adissi³3 Sobreira AEG, Adissi PJ. Agrotóxicos: Falsas Premissas e Debates. Cien Saude Colet 2003; 8(4):985-990. believe that one of the causes leading to the higher number of poisoning cases is the large scale use of pesticides, resulting in a large number of deaths and illnesses of workers inhaling the product inadvertently during the application or through skin contact. Thus, pesticides affect both nature and collective health conditions, since pesticide residues can be ingested through food, as these compounds are potentially toxic to humans.

In a research on the effects of pesticides on health, work and environment for Brazilian municipalities, Pignati et al.²³23 Pignati WA, Oliveira NP, Silva AMC. Vigilância aos agrotóxicos: quantificação do uso e previsão de impactos na saúde-trabalho-ambiente para os municípios brasileiros. Cien Saude Colet 2014; 19(12):4669-4678. presented mean data on pesticide use in the state of Mato Grosso of 10 liters per hectare, and this excessive consumption makes Brazil the pesticide consumption world champion, consequently generating poisoning in the environment and the health of the population.

Accidental exposure includes poisoned people who may come into contact with pesticides in domestic environments by repelling insects when people reuse the product bottle by introducing some other substance, causing domestic accidents with packaging confusion, especially concerning children and older adults.

The drift effect is also included in this type of exposure, which is the aerial transport of pesticide particles to areas other than their application sites, such as homes next to sugarcane, soy or corn crops.

As for the intentional exposure, which is divided into attempted suicide and attempted homicide in this study, we find poisonings caused by the intention of taking one’s own life, or someone else’s. Poisoning by attempted suicide has the highest lethality rates.

The analysis should not be hasty. A higher number of suicide poisonings is serious and should be treated besides a fortuitous situation or domestic accident. In Table 2, we can identify the main circumstances of poisoning in Goiás from 2005 to 2015.

Regarding the circumstance of poisoning notifications, Table 3 shows the attempted suicide as the most frequent poisoning (36.4% of the notifications - 1,086 cases), deserving future studies on this health problem, since discussion should be further expanded, bringing elements about the individual’s health care model and the psychosocial care network.

Nevertheless, this result is linked to chronic poisoning due to years of exposure to the application of pesticides, which causes immunological, hematological, hepatic, neurological problems, congenital malformations, tumors. It is assumed that these health problems can lead to depressive symptoms, along with high levels of suicide attempts.

Another important aspect to understand the greater number of pesticide poisoning-related suicides concerns psychic disorders caused by exposure to pesticides, especially organophosphates, although they are not the only ones, among which are depression and anxiety¹³13 Araújo AJ, Lima JS, Moreira JC, Jacob SC, Soares MO, Monteiro MCM, Amaral AM, Kubota A, Meyer A, Cosenza CAN, Neves CN, Markowitz S. Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 2007; 12(1):115-130.^,2424 Meyer TF, Resende IL, Abreu JC. Incidência de suicídios e uso de agrotóxicos por trabalhadores rurais em Luz (MG), Brasil. Rev Bras Saúde Ocup 2007; 32(116):24-30..

Some case studies conducted in Brazil indicate this perspective. Part of these studies weaves this correlation preliminarily, as is the case of the work “Incidence of suicides and use of pesticides by rural workers in Luz (MG), Brazil”²⁴24 Meyer TF, Resende IL, Abreu JC. Incidência de suicídios e uso de agrotóxicos por trabalhadores rurais em Luz (MG), Brasil. Rev Bras Saúde Ocup 2007; 32(116):24-30..

When carrying out a study on pesticide exposure among peasants in Nova Friburgo (RJ), Araújo et al.¹³13 Araújo AJ, Lima JS, Moreira JC, Jacob SC, Soares MO, Monteiro MCM, Amaral AM, Kubota A, Meyer A, Cosenza CAN, Neves CN, Markowitz S. Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 2007; 12(1):115-130. identified a direct relationship between this use and psychiatric disorders.

Scientific evidence shows that exposure to pesticides can lead to health damage, often irreversible, such as the case of late neuropathy due to overexposure to organophosphates. The neurotoxic consequences of acute exposure to high concentrations of pesticides are also well established, whether the effects are muscarinic, nicotinic, and on the central and peripheral nervous system¹³13 Araújo AJ, Lima JS, Moreira JC, Jacob SC, Soares MO, Monteiro MCM, Amaral AM, Kubota A, Meyer A, Cosenza CAN, Neves CN, Markowitz S. Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 2007; 12(1):115-130.(p.116).

The study by Araújo et al.¹³13 Araújo AJ, Lima JS, Moreira JC, Jacob SC, Soares MO, Monteiro MCM, Amaral AM, Kubota A, Meyer A, Cosenza CAN, Neves CN, Markowitz S. Exposição múltipla a agrotóxicos e efeitos à saúde: estudo transversal em amostra de 102 trabalhadores rurais, Nova Friburgo, RJ. Cien Saude Colet 2007; 12(1):115-130. explains the high number of suicide-related poisoning notifications. Chronic poisoning due to years of exposure to pesticides, both occupationally and environmentally and by their (accidental) ingestion, causes severe damage to mental and cardiovascular health, resulting in depression of the subject who is no longer able to work due to cardiovascular harm, or even his depression directly generated by poisoning.

Occupational poisonings totaled 1,078 notifications (36.1% of notifications), and as already addressed, such poisonings may in the future lead to possible notifications for suicide, since poisoned workers end up with chronic diseases.

As for occupational and accidental circumstances, we can highlight two data from the 2006 Agricultural Census²²22 Instituto Brasileiro de Geografia e Estatísticas (IBGE). Censo Agropecuário 2006. Brasília/Rio de Janeiro: IBGE; 2010., of which part of rural producers are illiterate, and 51% are illiterate in the state of Goiás. We cannot assume, a priori, that low education means poor knowledge. In essence, there is extensive and fruitful popular and traditional knowledge (know-how) among the different groups of rural workers, but not exactly regarding pesticides, a product of an urban-industrial western civilization that requires technical assistance and proper handling.

Another important fact is that technical assistance remains very limited, and occurs in only 22% of rural establishments - whose mean area is 228 hectares. The 2006 Agricultural Census²²22 Instituto Brasileiro de Geografia e Estatísticas (IBGE). Censo Agropecuário 2006. Brasília/Rio de Janeiro: IBGE; 2010. shows that more than half of the establishments in Brazil where pesticides were used did not receive technical guidance (785,000 or 56.3%). The backpack sprayer, which is the application equipment with the greatest potential for exposure to pesticides, is used in 973,000 establishments. Empty packages are burned or buried in 358,000 establishments, and 296,000 establishments did not use any personal protective equipment. Most adopted only boots and hats in the establishments that used PPEs.

Analyzing these data, we can understand some of the observations in the poisoning notification forms that report poisoning due to the intake of soft drinks in a container that was contaminated by pesticides or pesticide consumption when mistaken for any drink.

Table 4 highlights pesticides that were the agents with the highest incidence of poisoning. First is Roundup (Glyphosate), with 725 cases, followed by Furadan (Carbofuran), with 337 cases, 2,4-D (Dichlorophenoxyacetic acid), with 116 cases, Regent (Phenylpyrazole), with 64 cases, Aldrin (Organochlorine) with 51 cases, and Furazin (Carbamate), with 34 cases.

The clinical effects of the poisoned individual when coming into contact with any of the pesticides mentioned above may range from mucosal irritation to the development of cancer. In research by Samsel and Seneff²⁵25 Samsel A, Seneff S. Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases. Entropy 2013; 15(4):1416-1463., tests indicate that glyphosate, Roundup’s active ingredient, will cause 50% of autism in children by 2025, and other modern diseases such as depression, infertility, Alzheimer’s, cancer and heart disease.

Corroborating these predictions, the Guide for the Prevention, Notification, and Treatment of Poisoning by Pesticides²⁶26 Mato Grosso do Sul. Centro Integrado de Vigilância Toxicológica - Centro Estadual de Referência em Saúde do trabalhador. Guia de prevenção, notificação e tratamento das intoxicações por agrotóxicos. Campo Grande: CIVITOX/CEREST; 2013. considers that pesticides with the active ingredient Carbamate, such as Furazin and Furadan (Carbofuran), can cause pulmonary edema, depression, respiratory paralysis, memory loss and even motor difficulties in the poisoned.

Organochlorine insecticides, such as Aldrin, can cause vertigo, corneal clouding, respiratory failure, testicular atrophy and consequent infertility, and cancer. Furthermore, 2,4-Dichlorophenoxyacetic acids (2,4-D) cause anything from irritation in the eyes and mucous membranes to cardiorespiratory arrest. It is important to note that insecticide Aldrin was banned in Brazil from 1985. However, as can be seen, it is still in use.

Development of exposure situations

Regarding the development of poisoning cases, we have some nomenclatures, such as death, death from another cause, cure (in which the poisoned person died from another occurrence, such as murder or suicide), cure with sequelae (in which the poisoned person acquired some sequel, such as neurological or pulmonary disease, among others). We can analyze Table 5 to identify the development of poisoning cases in the State of Goiás.

Although occupational deaths represent a small proportion, each of these fatalities carries much information, since, behind each death, several workers are living under the same conditions, and exposed to the same risk factors. Thus, it can be said that “little means a lot”²⁷27 Bochner R. Óbito ocupacional por exposição a agrotóxicos utilizado como evento sentinela: quando pouco significa muito. Vigil Sanit Debate 2015; 3(4):39-49., that a lost life must be considered and never neglected.

Thus, cases of cure can conceal alarming amounts of chronically poisoned individuals who, over time, may manifest cancers, Alzheimer’s, infertility, and heart and respiratory diseases. So what cure are we talking about? Nevertheless, according to the research contained in the “ABRASCO Dossier. Warning about the impacts of pesticides on health. Part 1 - Pesticides, Food Safety, and Health”²⁸28 Carneiro FF, Pignati WA, Rigotto, RM, Augusto LGS, Rizollo A, Muller N. Dossiê ABRASCO: Um alerta sobre os impactos dos agrotóxicos na saúde. Parte 1 - Agrotóxicos, Segurança Alimentar e Saúde. Rio de Janeiro: ABRASCO; 2012., these chronic effects can occur months, years or even decades after exposure, manifesting in various diseases such as cancers, congenital malformations, endocrine, neurological and mental disorders.

Final considerations

The study presented raised information presented in the CIT-GO Pesticide Poisoning Forms, systematizing indicators such as the period of the year with the highest poisoning levels, the most affected age, development of poisoning cases, and municipalities with the highest incidence of poisonings.

In this analysis, we realized that the proportion of poisoning per inhabitant should be considered so that actual numbers or those closer to reality are presented. Thus, a high incidence of pesticide poisoning is observed in the region of Goiânia (probably due to the number of inhabitants of this municipality), Formosa (major soybean producer) and the Southern Mesoregion of Goiás, a region territorialized by agribusiness, with the massive cultivation of soybeans and corn and with a recent advance in sugarcane agribusiness.

Regarding the item present in the pesticide poisoning notification forms regarding the “case development”, which contains information on death, cure, cure with sequelae and death from another cause, of the 2,987 notifications, 113 people died, 98 people were cured with sequelae and 2,774 were diagnosed with “cure”. However, it should be noted that the chronic (long-term) effects of pesticides are not recorded, as Bochner²⁹29 Bochner R. Sistema Nacional de Informações Tóxico-Farmacológicas - SINITOX e as intoxicações humanas por agrotóxicos no Brasil. Cien Saude Colet 2007; 12(1):73-89. points out, even because these effects take time to manifest.

Thus, there is a need to expand knowledge about the chronic health effects of the population exposed to these products, as there may be a false indicator regarding the diagnosis of a cure for poisoning that may manifest itself decades later. However, one must ask what cure is mentioned when the subject is the prognosis of improved initial poisoning symptoms.

Acknowledgments

We are grateful to the Coordination for the Improvement of Higher Education Personnel (CAPES) for the financial support and granting of scholarships.

References

Publication Dates

History