ABSTRACT

OBJECTIVE

Describe the main work risks for sugarcane cutters and their effects on workers’ health.

METHODS

Critical review of articles, with bibliographic research carried out in the PubMed, SciELO Medline, and Lilacs databases. The following keywords were used: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açú car , and colheita de cana -de-açúcar . The inclusion criteria were articles published between January 1997 and June 2017, which evaluated working conditions and health effects on sugarcane cutters. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter’s health were excluded. The final group of manuscripts was selected by the lead author of this study and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author.

RESULTS

From the 89 articles found, 52 met the selection criteria and were evaluated. Studies have shown that cutters work under conditions of physical and mental overload, thermal overload, exposure to pollutants, and are subject to accidents. The main effects observed were respiratory, cardiovascular, renal, musculoskeletal, heat stress, dehydration, genotoxic, and those due to accidents.

CONCLUSIONS

Work on the manual cutting of sugarcane, especially of burned sugarcane, exposes workers to various risks, with different health impacts. Risk reduction for exposure to pollution and thermal and physical overload is required as a measure to preserve the health of the worker.

Rural Workers; Health Status; Working Conditions; Occupational Risks; Occupational Health; Review

INTRODUCTION

Sugarcane is widely cultivated in Latin America, in Asia, and in Brazil, the world’s largest producer ¹1. Food and Agricultural Organization of the United Nations (FAO). Prodution. Crops. Rome; 2016 [cited 2018 Feb 16]. Available from: http://www.fao.org/faostat/en/#data/QC
http://www.fao.org/faostat/en/#data/QC... . Because of the oil crisis, ethanol production in Brazil gained momentum as fuel used in automotive vehicles and reduced the cost of petroleum products imports starting in 1970. There was a large increase in sugarcane production in the country to replace fossil fuels with biofuels, in addition to meeting the demand for sugar ²2. Carvalho SADD, Furtado AT. O melhoramento genético de cana-de-açúcar no Brasil e o desafio das mudanças climáticas globais . Rev Gest Conex . 2013;2(1):22-46. https://doi.org/10.13071/regec.2317-5087.2013.2.1.4909.22-46
https://doi.org/10.13071/regec.2317-5087... ^,33. Uriarte M, Yackulic CB, Cooper T, Flynn D, Cortes M, Crk T, et al. Expansion of sugarcane production in São Paulo, Brazil: implications for fire occurrence and respiratory health . Agric Ecosyst Environ . 2009;132(1-2):48-56. https://doi.org/10.1016/j.agee.2009.02.018
https://doi.org/10.1016/j.agee.2009.02.0... . This new scenario boosted the development of new production regions in the state of São Paulo and in the Northeast region, and expanded production to Paraná, Goiás, Mato Grosso, and Mato Grosso do Sul. The growth of sugarcane production in Brazil (768 million tons of sugarcane in the 2016 harvest), also occurs in Asian countries, most notably in India (348 million tons), China (123 million tonnes), and Thailand (87 million tonnes) ¹1. Food and Agricultural Organization of the United Nations (FAO). Prodution. Crops. Rome; 2016 [cited 2018 Feb 16]. Available from: http://www.fao.org/faostat/en/#data/QC
http://www.fao.org/faostat/en/#data/QC... .

The manual harvesting of sugarcane has used the practice of burning straw to facilitate manual cutting, reducing water content and thereby increasing sugar content, as well as eliminating venomous animals ⁴4. Arbex MA, Bohm GM, Saldiva PH, Conceição GM, Pope AC 3rd, Braga AL. Assessment of the effects of sugar cane plantation burning on daily counts of inhalation therapy . J Air Waste Manag Assoc . 2000;50(10):1745-9. https://doi.org/10.1080/10473289.2000.10464211
https://doi.org/10.1080/10473289.2000.10... . However, the burning of sugarcane straw is responsible for the emission of large quantities of pollutants that contribute to adverse effects on the health ⁵5. Mazzoli-Rocha F, Magalhães CB, Malm O, Saldiva PH, Zin WA, Faffe DS. Comparative respiratory toxicity of particles produced by traffic and sugar cane burning . Environ Res . 2008;108(1):35-41. https://doi.org/10.1016/j.envres.2008.05.004
https://doi.org/10.1016/j.envres.2008.05... of workers and populations of cities near the burning regions. The practice of burning, although it occurs in several countries, is more widespread in Brazil. The country ranked first in the emissions of biomass burning from sugarcane in 2016 (6.6 million tons), followed by India and China (3.2 and 1.1 million, respectively) ⁶6. Food and Agricultural Organization of the United Nations (FAO). Emissions – Agriculture. Burning – Crop Residues. Rome; 2016 [cited 2018 Feb 16]. Available from: http://www.fao.org/faostat/en/#data/GB
http://www.fao.org/faostat/en/#data/GB... .

State Law 11,241/2002 was approved in the State of São Paulo, after pressure from environmental movements, researchers, and the population of affected cities. This law gradually banned the burning of sugarcane, seeking to end it by 2031. With the increase of pressures, the Agro-Environmental Protocol of the State of São Paulo was signed in 2007, which anticipated the deadlines for eliminating the practice of burning in 2014 in flat areas and 2017 in rough terrain ⁷7. União da Indústria de Cana de Açúcar. Protocolo Agroambiental do Setor Sucroalcooleiro. São Paulo: UNICA; 2009 [cited 2017 Mar 14]. Available from: http://www.unica.com.br/protocolo-agroambiental/
http://www.unica.com.br/protocolo-agroam... . However, the burning of sugarcane prior to manual cutting is still performed in some regions of Brazil and in several countries, even with proven adverse effects ⁷7. União da Indústria de Cana de Açúcar. Protocolo Agroambiental do Setor Sucroalcooleiro. São Paulo: UNICA; 2009 [cited 2017 Mar 14]. Available from: http://www.unica.com.br/protocolo-agroambiental/
http://www.unica.com.br/protocolo-agroam... .

In the last 20 years, there have been studies that evaluated the working conditions and health effects of rural cane cutters. During manual cutting, workers are exposed to a number of health hazards, such as: physical hazards – weather conditions (high temperatures, solar radiation, rain), noise emitted by vehicles; chemical hazards – gases and particulate matter from burning cane, soil, and pesticide residues; biological hazards – venomous animals; risks of accidents: traumas and fire; ergonomic risks – repetitive postures and movements, physical overload, and mental risks imposed by the work rhythm, constant attention, concentration, and lack of regular pauses ⁸8. Ribeiro H, Ficarelli TRA. Queimadas nos canaviais e perspectivas dos cortadores de cana-de-açúcar em Macatuba, São Paulo . Saude Soc. 2010;19(1):48-63. https://doi.org/10.1590/S0104-12902010000100005
https://doi.org/10.1590/S0104-1290201000... ^,99. Rocha FLR, Marziale MHP, Hong OS. Work and health conditions of sugar cane workers in Brazil . Rev Esc Enferm USP . 2010;44(4):978-83. https://doi.org/10.1590/S0080-62342010000400017
https://doi.org/10.1590/S0080-6234201000... . Studies conducted in Central American countries with sugarcane cutters also show high morbidity and mortality, mainly associated with the epidemic of chronic kidney disease^10–12. Despite several studies, there is a lack of systematization of the findings and evidence, as well as of the suggested measures to preserve the health of the workers.

This review aimed to describe the risks of sugarcane cutters’ work and its effects on workers’ health.

METHODS

Bibliographic search in databases: PubMed, SciELO, Medline, and Lilacs. The inclusion criteria were: articles published in Portuguese and English, between January 1997 and June 2017, during which time a greater number of studies that could be accessed in full were published. The articles were selected based on the analysis of their titles, followed by their abstract. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter’s health were excluded. The keywords used to search the databases were: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açúcar , and colheita de cana-de- açúcar . The final set of manuscripts was selected by the lead author and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author.

Of the 89 articles evaluated, 13 were discarded after the title analysis, 22 after reading the abstract or the full text, and two because they were not accessible in their entirety, leaving 52 articles included ( Figure ).

RESULTS AND DISCUSSION

The list of 52 evaluated articles, grouped according to the topics discussed, is shown in Box 1 and 2 and are detailed below.

Work Environment and Organization

The process of manual cane cutting is an activity that imposes a high physical load on the cutter, since it requires the performance of vigorous, fast, and repetitive movements with a machete. In addition, there is the loading of the sugarcane bundles ⁹9. Rocha FLR, Marziale MHP, Hong OS. Work and health conditions of sugar cane workers in Brazil . Rev Esc Enferm USP . 2010;44(4):978-83. https://doi.org/10.1590/S0080-62342010000400017
https://doi.org/10.1590/S0080-6234201000... . The manual cutting of cane requires the cutting of several canes near the ground and their gathering in bundles that weigh about 10 kg to 15 kg. The bundles are loaded for about two to five meters and arranged in rows to be picked up by the trucks that transport them to the mill for grinding ³⁴34. Zimmerman JL, Shen MC. Rhabdomyolysis . Chest . 2013;144(3):1058-65. https://doi.org/10.1378/chest.12-2016
https://doi.org/10.1378/chest.12-2016... . Payment per production is an additional risk factor, as it induces a longer rate of work to guarantee a slightly better wage and a greater possibility of hiring in subsequent harvests ⁸8. Ribeiro H, Ficarelli TRA. Queimadas nos canaviais e perspectivas dos cortadores de cana-de-açúcar em Macatuba, São Paulo . Saude Soc. 2010;19(1):48-63. https://doi.org/10.1590/S0104-12902010000100005
https://doi.org/10.1590/S0104-1290201000... .

This study recorded the activities in films and allowed a more precise analysis of the activity in the cutting of burned sugarcane. During the workday, a worker that cuts 13 tons/day performs, on average, 3,100 spinal pushups, 3,500 machete blows, and 1,000 rotations of the lumbar spine ¹³13. Vilela RAG, Laat EF, Luz VG, Silva AJN, Takahashi MAC. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar . Rev. Bras Saude Ocup. 2015;40(131):30-48. https://doi.org/10.1590/0303-7657000075413
https://doi.org/10.1590/0303-76570000754... .

In addition, these workers are directly exposed to the pollutants generated by the burning of sugarcane and are constantly subject to adverse climatic conditions because the work is performed outdoors ¹⁰10. Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med . 2015;58(5):541-8. https://doi.org/10.1002/ajim.22450
https://doi.org/10.1002/ajim.22450... ^,1414. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... ^,1515. Crowe J, Wesseling C, Solano BR, Umaña MP, Ramirez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica . Am J Ind Med . 2013;56(10):1157-64. https://doi.org/10.1002/ajim.22204
https://doi.org/10.1002/ajim.22204... . Work that requires physical exertion and high-temperature environment imposes risks of overload and thermal stress. This is aggravated by the use of overlapping clothing to reduce sun exposure, which hinders heat dispersion. In general, they do not take breaks, in disagreement with the Regulatory Standard – 15 of the Ministry of Labor and Employment – Order 3214/78, for thermal overload. For physical activity, the Standard provides a 15-minute working regime for 45 minutes of rest for Wet-Bulb Temperature – Globe Thermometer (IBUTG) values between 28°C and 30°C for activities with intense physical effort, as occurs with cutters, and work with IBUTG above 30°C ¹³13. Vilela RAG, Laat EF, Luz VG, Silva AJN, Takahashi MAC. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar . Rev. Bras Saude Ocup. 2015;40(131):30-48. https://doi.org/10.1590/0303-7657000075413
https://doi.org/10.1590/0303-76570000754... is not allowed.

The improper provision of personal equipment such as gloves and goggles, inadequate feeding and hydration and poor health conditions complement the environment and the work process to which these workers are subjected ¹⁶16. Abrahão RF, Gonzaga MC, Braunbeck OA. Protective gloves on manual sugar cane cutting are really effective? Work . 2012;41 Suppl 1:4963-6. https://doi.org/10.3233/wor-2012-0039-4963
https://doi.org/10.3233/wor-2012-0039-49... ^,1717. Alves F. Por que morrem os cortadores de cana? Saude Soc . 2006;15(3):90-8. https://doi.org/10.1590/S0104-12902006000300008
https://doi.org/10.1590/S0104-1290200600... .

Respiratory Symptoms and Pulmonary Function

The inhalation of particulate matter released during the cutting of burned cane can affect the upper and lower airways, causing symptoms and respiratory diseases, as well as lung function impairment in the workers ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... .

Goto et al. ¹⁹19. Goto DM, Lança M, Obuti CA, Barbosa CMG, Saldiva PHN, Zanetta DMT, et al. Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting . Environ Res . 2011;111(5):664-9. https://doi.org/10.1016/j.envres.2011.03.006
https://doi.org/10.1016/j.envres.2011.03... carried out a study involving 30 sugarcane cutters, with the main objective of evaluating nasal mucociliary transport, comparing the period of the harvest with the pre-harvest period. The authors did not observe differences in lung function between the periods. However, Prado et al. ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... developed a study with a larger number of workers and a control group, which evaluated respiratory symptoms and lung function. They found a higher prevalence of respiratory symptoms and a decrease in pulmonary function among sugarcane cutters during the harvest period compared to pre-harvest, with a decline in forced expiratory volume in the first second (FEV₁), forced expiratory volume in the first second/forced vital capacity (FEV₁/FVC), and forced expiratory flow (FEF25-75%), characterizing an evolution with a pattern of obstructive ventilatory disorder. A study by Ferreira-Ceccato et al. ²⁰20. Ferreira-Ceccato AD, Ramos EMC, Carvalho LCS Jr, Xavier RF, Teixeira MFS, Raymundo-Pereira PA, et al. Short-term effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters . Respir Med . 2011;105(11):1766-8. https://doi.org/10.1016/j.rmed.2011.08.003
https://doi.org/10.1016/j.rmed.2011.08.0... evaluated the acute effects, i.e., four hours after the start of work, on the first day of harvest of burned cane and did not observe any complaint of nasal symptoms in any of the evaluated workers. However, the presence of symptoms is not a marker sensitive to the acute effect assessed by the study, thus limiting its interpretation.

Despite the increase in respiratory symptoms due to the burning of sugarcane, few studies have evaluated pulmonary function in cane cutters. Studies with more numbers of evidence are recommended to confirm these findings.

Nasal Mucociliary Defense

The inhalation of pollutants increases with physical exertion, since it requires greater pulmonary ventilation. This implies an increased risk of nasal inflammation with increased production of proinflammatory cytokines ⁸8. Ribeiro H, Ficarelli TRA. Queimadas nos canaviais e perspectivas dos cortadores de cana-de-açúcar em Macatuba, São Paulo . Saude Soc. 2010;19(1):48-63. https://doi.org/10.1590/S0104-12902010000100005
https://doi.org/10.1590/S0104-1290201000... ^,2121. Eeden SF, Tan WC, Suwa T, Mukae H, Terashima T, Fujii T, et al. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)) . Am J Respir Crit Care Med . 2001;164(5):826-30. https://doi.org/10.1164/ajrccm.164.5.2010160
https://doi.org/10.1164/ajrccm.164.5.201... ^,2222. Leonardi GS, Houthuijs D, Steerenberg PA, Fletcher T, Armstrong B, Antova T, et al. Immune biomarkers in relation to exposure to particulate matter: a cross-sectional survey in 17 cities of Central Europe . Inhal Toxicol . 2000;12 Suppl 4:1-14. https://doi.org/10.1080/089583700750019486
https://doi.org/10.1080/0895837007500194... , with changes in nasal mucociliary clearance ¹⁹19. Goto DM, Lança M, Obuti CA, Barbosa CMG, Saldiva PHN, Zanetta DMT, et al. Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting . Environ Res . 2011;111(5):664-9. https://doi.org/10.1016/j.envres.2011.03.006
https://doi.org/10.1016/j.envres.2011.03... ^,2020. Ferreira-Ceccato AD, Ramos EMC, Carvalho LCS Jr, Xavier RF, Teixeira MFS, Raymundo-Pereira PA, et al. Short-term effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters . Respir Med . 2011;105(11):1766-8. https://doi.org/10.1016/j.rmed.2011.08.003
https://doi.org/10.1016/j.rmed.2011.08.0... .

Two studies evaluated the mucociliary clearance in cane cutters. The study by Goto et al. ¹⁹19. Goto DM, Lança M, Obuti CA, Barbosa CMG, Saldiva PHN, Zanetta DMT, et al. Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting . Environ Res . 2011;111(5):664-9. https://doi.org/10.1016/j.envres.2011.03.006
https://doi.org/10.1016/j.envres.2011.03... , which evaluated 27 workers, showed that, in the harvest period, there was a reduction of 80% in the mucociliary clearance, with an increase in the saccharin transit time (STT) by 7.8 minutes and a reduction of 31% in the transportability of mucus. Ferreira-Ceccato et al. ²⁰20. Ferreira-Ceccato AD, Ramos EMC, Carvalho LCS Jr, Xavier RF, Teixeira MFS, Raymundo-Pereira PA, et al. Short-term effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters . Respir Med . 2011;105(11):1766-8. https://doi.org/10.1016/j.rmed.2011.08.003
https://doi.org/10.1016/j.rmed.2011.08.0... evaluated the acute effects of exposure to particulate matter from the burning of sugarcane biomass in the nasal mucociliary clearance of sugarcane cutters. The evaluations occurred seven days before work on the sugarcane harvest and four hours later, on the first day of the sugarcane harvest. A significant reduction in STT was observed in the harvest period. The difference observed between the studies mentioned ¹⁹19. Goto DM, Lança M, Obuti CA, Barbosa CMG, Saldiva PHN, Zanetta DMT, et al. Effects of biomass burning on nasal mucociliary clearance and mucus properties after sugarcane harvesting . Environ Res . 2011;111(5):664-9. https://doi.org/10.1016/j.envres.2011.03.006
https://doi.org/10.1016/j.envres.2011.03... ^,2020. Ferreira-Ceccato AD, Ramos EMC, Carvalho LCS Jr, Xavier RF, Teixeira MFS, Raymundo-Pereira PA, et al. Short-term effects of air pollution from biomass burning in mucociliary clearance of Brazilian sugarcane cutters . Respir Med . 2011;105(11):1766-8. https://doi.org/10.1016/j.rmed.2011.08.003
https://doi.org/10.1016/j.rmed.2011.08.0... can be explained by a mechanism similar to the one that occurs in smokers. In them, an increase in clearance at the beginning of tobacco consumption is observed, with shortening of STT as a defense response against aggression. Subsequently, with chronic exposure to tobacco smoke, changes in the rheology of mucus and hair cells, STT tends to increase^23–25.

Cardiovascular Changes

A study by Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... that evaluated 28 workers involved in sugarcane cutting during the harvest and pre-harvest observed a significant increase in blood pressure values during the harvest period. Monitoring of 24-hour systemic blood pressure showed an increase of 3.7 mmHg in systolic blood pressure during the harvest. The study also showed the effect of increased sympathetic activity, directly recorded in the fibular nerve, associated with elevated blood pressure. This suggests an autonomic nervous system imbalance effect as one of the mechanisms possibly implicated in elevated blood pressure. In addition to changes in blood pressure, the study by Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... also observed a significant decrease in the time of thrombin and prothrombin during the harvest. This indicates increased blood coagulation, which increases the risk of thromboembolic phenomena, changes that may be associated with both the inhalation of pollutants from the burning of the cane and dehydration.

Vilela et al. ¹³13. Vilela RAG, Laat EF, Luz VG, Silva AJN, Takahashi MAC. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar . Rev. Bras Saude Ocup. 2015;40(131):30-48. https://doi.org/10.1590/0303-7657000075413
https://doi.org/10.1590/0303-76570000754... , in a study with 40 cane cutters, evaluated cardiovascular load (CVL). This index is used to evaluate the physiological impact of the work because it corresponds to the percentage of the heart rate at work in relation to the maximum allowed heart rate. They observed a significant effect between the increase of productivity and CVL. Each increase in the cut of one ton of sugarcane was associated with an increase of approximately 0.81% in CVL. This finding evidences the impact of increased production on heart overload, i.e., work paid by productivity imposing greater cardiovascular risk.

The studies suggest an impact on the cardiovascular system of sugarcane cutters evidenced by increased blood pressure, increased cardiovascular load, changes in the autonomic nervous system, and changes in blood coagulability during the harvest compared to the pre-harvest.

Inflammatory and Oxidative Stress Markers

The excessive physical exertion and exposure to heat and air pollutants to which workers are subjected during work in the cane harvest period may induce the development of oxidative stress and pulmonary and systemic inflammation^14,26–28.

Prado et al. ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... observed a reduction of antioxidant enzymes: catalase, glutathione S-transferase (GST), glutathione reductase (GR), and glutathione peroxidase (GPx) in sugarcane cutters at the end of the harvest period compared to the pre-harvest period. Levels of malondialdehyde (MDA), a lipid peroxidation product of the cell wall, increased. When combined with the decrease in antioxidant enzymatic activity, this finding supports a chronic state of oxidative stress among cutters. However, Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... reported an increase in GST, GPx antioxidant enzymes in the burned sugarcane harvest period, probably in response to aggression, although it evidenced an increase in MDA levels. The authors suggested that both processes, an attempt to defend against oxidizing agents with increased protective enzymes and cell wall damage by membrane oxidation, may be concomitant. Differences in individual characteristics, genetic polymorphism, working conditions, eating, and living conditions may explain the different findings in the antioxidant markers. The cutters in the study by Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... lived in the São Paulo region of Sorocaba-Piracicaba, SP, and those involved in the study by Prado et al. ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... were all migrants from Paraíba and Pernambuco, who worked in the region of São José do Rio Preto, SP, only during the harvests.

Other manifestations caused by strenuous work ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... ^,1818. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... are associated with the elevation of muscle injury biomarkers such as creatine kinase (CK) and lactate dehydrogenase (LDH), and electrolyte changes compatible with work under conditions of physical overload and hydroelectrolytic imbalance ²⁹29. Brancaccio P, Maffulli N, Limongelli FM. Creatine kinase monitoring in sport medicine . Br Med Bull . 2007;81-82(1):209-30. https://doi.org/10.1093/bmb/ldm014
https://doi.org/10.1093/bmb/ldm014... . The CK and LDH are biomarkers that may increase during situations of intense exercise, in which the cell membranes become more permeable and release various compounds into the blood, including myoglobin ³⁰30. Brancaccio P, Lippi G, Maffulli N. Biochemical markers of muscular damage. Clin Chem Lab Med . 2010;48(6):757-67. https://doi.org/10.1515/cclm.2010.179
https://doi.org/10.1515/cclm.2010.179... . In the study by Santos et al. ³¹31. Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction . Kidney Int . 2015;87(4):792-9. https://doi.org/10.1038/ki.2014.306
https://doi.org/10.1038/ki.2014.306... , there was an acute increase in CK serum levels, which increased from 120 IU/l before the beginning of the workday to 360 IU/l at the end of a day’s work day. In the study by Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... , although of small magnitude, elevations in serum levels of CK and DHL were observed during the harvest in relation to the pre-harvest period, suggesting chronic muscle injury.

Elevated levels of CK, DHL, and myoglobin in plasma result from muscle injury due to intense and strenuous physical exertion, which can be aggravated in unfavorable environmental conditions ³²32. Chlibková D, Knechtle B, Rosemann T, Tomásková I, Novotný J, Zákovská A, et al. Rhabdomyolysis and exercise-associated hyponatremia in ultra-bikers and ultra-runners . J Int Soc Sports Nutr . 2015;12:29. https://doi.org/10.1186/s12970-015-0091-x
https://doi.org/10.1186/s12970-015-0091-... . In addition, muscle damage with rhabdomyolysis is a factor associated with the development of acute kidney injury (AKI)^33–36, particularly in dehydration situations ³⁷37. Phajan T, Nilvarangkul K, Settheetham D, Laohasiriwong W. Work-related musculoskeletal disorders among sugarcane farmers in north-eastern Thailand. Asia Pac J Public Health . 2014;26(3):320-7. https://doi.org/10.1177/1010539514528026
https://doi.org/10.1177/1010539514528026... ^,3838. Crowe J, Moya-Bonilla JM, Román-Solano B, Robles-Ramírez A. Heat exposure in sugarcane workers in Costa Rica during the non-harvest season. Glob Health Action . 2010;3(1):1-9. https://doi.org/10.3402/gha.v3i0.5619
https://doi.org/10.3402/gha.v3i0.5619... . In addition to serum levels of CK and LDH, the excessive activity may induce increased ventilatory work with increased inhalation of nephrotoxic substances such as silica and metals ³⁹39. Gobe G, Crane D. Mitochondria, reactive oxygen species and cadmium toxicity in the kidney. Toxicol Lett . 2010;198(1):49-55. https://doi.org/10.1016/j.toxlet.2010.04.013
https://doi.org/10.1016/j.toxlet.2010.04... , increasing oxidative stress ²⁷27. Tanskanen M, Atalay M, Uusitalo A. Altered oxidative stress in overtrained athletes. J Sports Sci . 2010;28(3):309-17. https://doi.org/10.1080/02640410903473844
https://doi.org/10.1080/0264041090347384... and systemic inflammation ⁴⁰40. Hiraiwa K, Eeden SF. Contribution of lung macrophages to the inflammatory responses induced by exposure to air pollutants . Mediators Inflamm . 2013;2013:619523. https://doi.org/10.1155/2013/619523
https://doi.org/10.1155/2013/619523... . Santos et al. ³¹31. Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction . Kidney Int . 2015;87(4):792-9. https://doi.org/10.1038/ki.2014.306
https://doi.org/10.1038/ki.2014.306... observed a significant increase in leukocyte counts as well as neutrophils at the end of a working day for cane cutters during the harvest period. This indicates an inflammatory response probably associated with strenuous work, under high temperatures and exposure to pollutants.

The studies assessed revealed the occurrence of oxidative stress, increased concentrations of biomarkers for muscle injury and inflammatory cells in the blood. This is possibly associated with excessive physical stress at high temperatures and exposure to air pollution by sugarcane cutters during the harvest period.

Renal Effects

Health registries and research in Central America show the occurrence of a chronic kidney injury epidemic in rural workers^41–44. It was first described by Trabanino et al. ⁴²42. García-Trabanino R, Aguilar R, Reyes Silva C, Ortiz Mercado M, Leiva Merino R. Nefropatía terminal en pacientes de un hospital de referencia em El Salvador. Rev Panam Salud Publica . 2002 [cited 2017 Mar 14];12(3):202-6. Available from: https://scielosp.org/pdf/rpsp/2002.v12n3/202-206/es
https://scielosp.org/pdf/rpsp/2002.v12n3... and was renamed Mesoamerican nephropathy.

Despite several studies, its etiology has not been clarified. One of the hypotheses is that it can be caused by repeated episodes of acute renal damage due to daily dehydration associated with rhabdomyolysis, systemic inflammation, oxidative stress, genetic variations, and exposures to non-characterized pesticides ⁴²42. García-Trabanino R, Aguilar R, Reyes Silva C, Ortiz Mercado M, Leiva Merino R. Nefropatía terminal en pacientes de un hospital de referencia em El Salvador. Rev Panam Salud Publica . 2002 [cited 2017 Mar 14];12(3):202-6. Available from: https://scielosp.org/pdf/rpsp/2002.v12n3/202-206/es
https://scielosp.org/pdf/rpsp/2002.v12n3... . Wesseling et al. ¹¹11. Wesseling C, Aragón A, González M, Weiss I, Glaser J, Bobadilla NA, et al. Kidney function in sugarcane cutters in Nicaragua: a longitudinal study of workers at risk of Mesoamerican nephropathy . Environ Res . 2016;147:125-32. https://doi.org/10.1016/j.envres.2016.02.002
https://doi.org/10.1016/j.envres.2016.02... evaluated 29 sugarcane cutters in Nicaragua and found a significant decrease in renal function during the nine-week sugarcane cutting work. The estimated mean glomerular filtration rate decreased (9%, 10 mL/min), there was a significant increase in serum creatinine (20%), serum urea (41%), and four-fold elevation of lipocalin associated with neutrophils (NGAL), a biomarker for the early detection of renal damage. In the Santos et al. ³¹31. Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction . Kidney Int . 2015;87(4):792-9. https://doi.org/10.1038/ki.2014.306
https://doi.org/10.1038/ki.2014.306... study, which involved 28 sugarcane cutters evaluated before and after a working day at the end of the harvest period, there was a significant increase in urinary density, lower levels of serum sodium and fractional excretion of sodium (FeNa), as well as a significant increase in the hematocrit at the end of the working day, suggesting that the sugarcane cutters were dehydrated.

Dehydration, thermal stress, and volume depletion are known risk factors for the development of renal disease. In the study by Garcia-Trabanino et al. ⁴⁵45. Garcia-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador: a cross-shift study of workers at risk of Mesoamerican nephropathy . Environ Res . 2015;142:746-55. https://doi.org/10.1016/j.envres.2015.07.007
https://doi.org/10.1016/j.envres.2015.07... , the high prevalence of a reduction in the glomerular filtration rate was consistent with the dehydration caused by strenuous work in hot and humid environments. The cause may be related to decreased renal blood flow, increased demand for tubular reabsorption, and increased levels of uric acid ⁴⁵45. Garcia-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador: a cross-shift study of workers at risk of Mesoamerican nephropathy . Environ Res . 2015;142:746-55. https://doi.org/10.1016/j.envres.2015.07.007
https://doi.org/10.1016/j.envres.2015.07... .

Renal biopsies were performed in sugarcane workers in Nicaragua, and glomerulosclerosis, glomerular hypertrophy, signs of chronic glomerular ischemia, and tubulointerstitial damage and mild vascular alterations were found ⁴⁶46. Wijkström J, González-Quiroz M, Hernandez M, Trujillo Z, Hultenby K, Ring A, et al. Renal morphology, clinical findings, and progression rate in Mesoamerican nephropathy . Am J Kidney Dis . 2017;69(5):626-36. https://doi.org/10.1053/j.ajkd.2016.10.036
https://doi.org/10.1053/j.ajkd.2016.10.0... . This gave biological plausibility to the hypotheses raised ⁴⁵45. Garcia-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador: a cross-shift study of workers at risk of Mesoamerican nephropathy . Environ Res . 2015;142:746-55. https://doi.org/10.1016/j.envres.2015.07.007
https://doi.org/10.1016/j.envres.2015.07... .

Twelve studies reported impairment of renal function in sugarcane cutters. The following were found: decreased glomerular filtration rate, increased creatinine, urea, increased urinary density, and biomarkers for the early detection of renal damage. Work conditions cannot be ruled out as one of the factors that may have contributed to the chronic kidney disease epidemic in several Central American countries and some Asian countries, especially among sugarcane workers. However, the etiology and pathophysiology of the chronic renal injury epidemic in these workers is uncertain. We also do not know whether the repetition of acute injuries may be one of the causes associated with genetic characteristics, varied environmental exposures, and the use of anti-inflammatory drugs in the induction of chronic kidney disease.

Exposure to Potentially Carcinogenic Agents and Genotoxic Effects

Three studies ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... ^,4747. Vale Bosso RM, Amorim LMF, Andrade SJ, Rossini A, Marchi MRR, Ponce de Leon A, et al. Effects of genetic polymorphisms CYP1A1, GSTM1, GSTT1 and GSTP1 on urinary 1-hydroxypyrene levels in sugarcane workers . Sci Total Environ . 2006;370(2-3):382-90. https://doi.org/10.1016/j.scitotenv.2006.07.025
https://doi.org/10.1016/j.scitotenv.2006... ^,4848. Martinez-Valenzuela C, Rodríguez-Quintana AR, Meza E, Waliszewski SM, Amador-Muñóz O, Mora-Romero A, et al. Cytogenetic biomonitoring of occupationally exposed workers to ashes from burning of sugar cane in Ahome, Sinaloa, México . Environ Toxicol Pharmacol . 2015;40(2):397-401. https://doi.org/10.1016/j.etap.2015.07.010
https://doi.org/10.1016/j.etap.2015.07.0... carried out in sugarcane regions found increased values in the markers of exposure to aromatic hydrocarbons in workers involved in sugarcane cutting. A study involving 90 cutters showed that the concentration of 1-OH-Pyrene in the urine was 11 times higher in the harvest period than in the pre-harvest period ¹⁸18. Prado GF, Zanetta DM, Arbex MA, Braga AL, Pereira LA, Marchi MR, et al. Burnt sugarcane harvesting: particulate matter exposure and the effects on lung function, oxidative stress, and urinary 1-hydroxypyrene . Sci Total Environ . 2012;437:200-8. https://doi.org/1016/j.scitotenv.2012.07.069
https://doi.org/1016/j.scitotenv.2012.07... . This result was similar to those of Bosso et al. ⁴⁷47. Vale Bosso RM, Amorim LMF, Andrade SJ, Rossini A, Marchi MRR, Ponce de Leon A, et al. Effects of genetic polymorphisms CYP1A1, GSTM1, GSTT1 and GSTP1 on urinary 1-hydroxypyrene levels in sugarcane workers . Sci Total Environ . 2006;370(2-3):382-90. https://doi.org/10.1016/j.scitotenv.2006.07.025
https://doi.org/10.1016/j.scitotenv.2006... , who evaluated 39 cane cutters and found a 10-fold higher concentration of 1-OH-Pyrene in the urine during the harvest compared to the pre-harvest period. Martinez-Vanezuela et al. ⁴⁸48. Martinez-Valenzuela C, Rodríguez-Quintana AR, Meza E, Waliszewski SM, Amador-Muñóz O, Mora-Romero A, et al. Cytogenetic biomonitoring of occupationally exposed workers to ashes from burning of sugar cane in Ahome, Sinaloa, México . Environ Toxicol Pharmacol . 2015;40(2):397-401. https://doi.org/10.1016/j.etap.2015.07.010
https://doi.org/10.1016/j.etap.2015.07.0... evaluated chromosomal damage in rural workers with sugarcane burned in Sinaloa, Mexico. We analyzed 1,000 buccal epithelial cells from 60 exposed and 60 unexposed workers (controls) to determine micronucleus frequencies and other nuclear abnormalities. The results indicated higher values of micronuclei and nuclear abnormalities in the exposed subjects compared to those not exposed. The burning of sugarcane, which generates polycyclic hydrocarbons, represents a genotoxic risk for sugarcane workers.

Miscellaneous Effects

Studies have evaluated heat stress and dehydration in sugarcane cutters ¹⁰10. Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med . 2015;58(5):541-8. https://doi.org/10.1002/ajim.22450
https://doi.org/10.1002/ajim.22450... ^,1515. Crowe J, Wesseling C, Solano BR, Umaña MP, Ramirez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica . Am J Ind Med . 2013;56(10):1157-64. https://doi.org/10.1002/ajim.22204
https://doi.org/10.1002/ajim.22204... ^,3838. Crowe J, Moya-Bonilla JM, Román-Solano B, Robles-Ramírez A. Heat exposure in sugarcane workers in Costa Rica during the non-harvest season. Glob Health Action . 2010;3(1):1-9. https://doi.org/10.3402/gha.v3i0.5619
https://doi.org/10.3402/gha.v3i0.5619... ^,4949. Bitencourt DP, Ruas AC, Maia PA. Análise da contribuição das variáveis meteorológicas no estresse térmico associada à morte de cortadores de cana-de-açúcar . Cad Saude Publica . 2012;28(1):65-74. https://doi.org/10.1590/S0102-311X2012000100007
https://doi.org/10.1590/S0102-311X201200... ^,5050. Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1 . Occup Environ Med . 2016;73(6):409-16. https://10.1136/oemed-2016-103555
https://10.1136/oemed-2016-103555... . In the study by Crowe et al. ¹⁰10. Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med . 2015;58(5):541-8. https://doi.org/10.1002/ajim.22450
https://doi.org/10.1002/ajim.22450... , symptoms associated with exposure to heat or dehydration (headache, tachycardia, cramps, fever, nausea, dizziness, hand or foot edema, and dysuria) have been reported at least once a week among the 106 workers evaluated.

Roscani et al. ⁵¹51. Roscani RC, Bitencourt DP, Maia PA, Ruas AC. Risco de exposição à sobrecarga térmica para trabalhadores da cultura de cana-de-açúcar no Estado de São Paulo, Brasil . Cad Saude Publica . 2017;33(3):e00211415. https://doi.org/10.1590/0102-311x00211415
https://doi.org/10.1590/0102-311x0021141... , in a study that evaluated the risk of thermal overload in sugarcane cutters for four years in the State of São Paulo, observed that the IBUTG values exceeded the tolerance limits in about 7% of the days for heavy activity and at about 3% for moderate activity. These estimates contradict findings by Barbosa et al. ¹⁴14. Barbosa CM, Terra-Filho M, Albuquerque AL, Di Giorgi D, Grupi C, Negrão CE, et al. Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil . PLoS One . 2012;7(9):e46142. https://doi.org/10.1371/journal.pone.0046142
https://doi.org/10.1371/journal.pone.004... and Vilela et al. ¹³13. Vilela RAG, Laat EF, Luz VG, Silva AJN, Takahashi MAC. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar . Rev. Bras Saude Ocup. 2015;40(131):30-48. https://doi.org/10.1590/0303-7657000075413
https://doi.org/10.1590/0303-76570000754... However, this study ⁵¹51. Roscani RC, Bitencourt DP, Maia PA, Ruas AC. Risco de exposição à sobrecarga térmica para trabalhadores da cultura de cana-de-açúcar no Estado de São Paulo, Brasil . Cad Saude Publica . 2017;33(3):e00211415. https://doi.org/10.1590/0102-311x00211415
https://doi.org/10.1590/0102-311x0021141... presents a limitation, since the IBUTG data were not recorded directly in the work field. The measurements were performed using IBUTG estimates using data provided by the INMET – National Institute of Meteorology’s network of meteorological surface stations, which may have underestimated the measurements.

Bodin et al. ⁵⁰50. Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1 . Occup Environ Med . 2016;73(6):409-16. https://10.1136/oemed-2016-103555
https://10.1136/oemed-2016-103555... evaluated the feasibility of providing intervention (adequate water replacement and scheduled rest periods) during sugarcane cutting to avoid heat stress and dehydration, without decreasing productivity. Post-intervention water consumption increased by 25%, the symptoms associated with thermal stress and dehydration declined, and daily cane production increased from 5.1 to 7.3 tons/person/day. Cortez et al. ⁵²52. Delgado Cortez O. Heat stress assessment among workers in a Nicaraguan sugarcane farm. Glob Health Action . 2009;2. https://doi.org/10.3402/gha.v2i0.2069
https://doi.org/10.3402/gha.v2i0.2069... also observed that workers with higher water consumption increased daily production from 5.5 to 8 tons of cut cane. In the study by Chiarello et al. ⁵³53. Chiarello P, Scatena Sobrinho P, Vieira MNCM, Diez Garcia RW. Protein-energy supplements to preserve nutritional status of sugar cane cutters . Occup Med (Lond) . 2006;56(8):575-7. https://doi.org/10.1093/occmed/kql103
https://doi.org/10.1093/occmed/kql103... , after the use of protein and electrolyte supplements, the reductions in body mass index and percentage of body fat with lean mass maintenance were significant. In addition, there was an improvement in the hydration state of 15 sugarcane cutters during the harvest. These studies ⁵⁰50. Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1 . Occup Environ Med . 2016;73(6):409-16. https://10.1136/oemed-2016-103555
https://10.1136/oemed-2016-103555... ^,5252. Delgado Cortez O. Heat stress assessment among workers in a Nicaraguan sugarcane farm. Glob Health Action . 2009;2. https://doi.org/10.3402/gha.v2i0.2069
https://doi.org/10.3402/gha.v2i0.2069... ^,5353. Chiarello P, Scatena Sobrinho P, Vieira MNCM, Diez Garcia RW. Protein-energy supplements to preserve nutritional status of sugar cane cutters . Occup Med (Lond) . 2006;56(8):575-7. https://doi.org/10.1093/occmed/kql103
https://doi.org/10.1093/occmed/kql103... , aimed at meeting employer rationality, increasing production and immediate wage gains, did not consider the acute and chronic harmful effects that are caused by the effort made to increase production. On the other hand, Luz et al. ⁵⁴54. Luz VG, Zangirolani LTO, Vilela RAG, Corrêa Filho HR. Consumo alimentar e condições de trabalho no corte manual de cana de açúcar no estado de São Paulo . Saude Soc. 2014;23(4):1316-28. https://doi.org/10.1590/S0104-12902014000400016
https://doi.org/10.1590/S0104-1290201400... , in a study which carried out direct observation of a fieldwork with 40 sugarcane cutters, concluded that the manual cutting of cane is strenuous and the payment per production can be an aggravating factor for health. The authors suggest that correct nutrition and hydration could minimize wear and tear and pain during work.

A review study by Alessi et al. ⁵⁵55. Alessi NP, Navarro VL. Saúde e trabalho rural: o caso dos trabalhadores da cultura canavieira na região de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica . 1997;13 Supl 2:S111-21. https://doi.org/10.1590/S0102-311X1997000600010
https://doi.org/10.1590/S0102-311X199700... addressed the effect of the working process on sugarcane cutter health and suggests that the daily exposure of cane cutters to physical, chemical, and biological loads becomes a series of diseases, trauma or related accidents ⁵⁵55. Alessi NP, Navarro VL. Saúde e trabalho rural: o caso dos trabalhadores da cultura canavieira na região de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica . 1997;13 Supl 2:S111-21. https://doi.org/10.1590/S0102-311X1997000600010
https://doi.org/10.1590/S0102-311X199700... . The movements and postures adopted during the work may predispose the cutters to injuries due to repetitive stresses or musculoskeletal diseases ⁵⁶56. Messias IA, Okuno E. Study of postures in sugarcane cutters in the Pontal of Paranapanema-SP, Brazil. Work . 2012;41 Suppl 1:5389-91. https://doi.org/10.3233/wor-2012-0828-5389
https://doi.org/10.3233/wor-2012-0828-53... . Rocha et al. ⁵⁷57. Rocha FLR,Palucci Marziale MHP, Robazzi MLCC. Poverty as a predisposing factor of illness tendencies in sugar cane workers . Rev Lat Am Enfermagem . 2007;15 Nº Espec:736-41. https://doi.org/10.1590/S0104-11692007000700004
https://doi.org/10.1590/S0104-1169200700... evaluated individual, social, and environmental factors predisposing 39 workers to illness and observed that the main determinants for illness were physical exertion, fast pace of work, living conditions, and poverty.

Most studies that address the environment and work organization are qualitative. This type of study is greatly relevant to qualify risks and problems raised by workers. However, there are limitations to better assess the risks and health effects on workers, as they are usually only conducted through interviews.

Despite the implementation of laws and measures that provide for the elimination of sugarcane burning, this practice is still carried out in several regions of Brazil and in several countries. Because this work is aggressive to health, even when the cut is made in non-burned cane, this activity must undergo changes to protect workers. These changes should include a review of production gain, elimination of pre-harvest burning, mechanization, and the existence of breaks at work. This process must be carried out with the participation of the workers so that the use of new technologies and the establishment of public policies that compensate for lost jobs may be properly implemented. In addition, there must be a qualification of workers, so that they may occupy the new jobs generated by mechanization.

CONCLUSION

Work in the manual cutting of sugarcane, especially when the cane is burned, exposes workers to several risks responsible for health problems – respiratory, renal, cardiovascular, osteomuscular, ocular, and dermatological.

REFERENCES

Publication Dates

History