**4. Occupational health & safety (OHS) (clinical recommendations)**

**3. Pesticides poisonings**

62 Insecticides - Development of Safer and More Effective Technologies

2007; Soares& Porto 2012).

**3.2 Acute toxicity**

many of them are irreversible.

**3.1. Prevalence of pesticides poisoning**

Agro-chemical industry has offered thousands of compounds. The climatic condition of Pak‐ istanfavors pest build up that destroys about 20 percent of potential agricultural crop. The health of the pesticides handlers and farmers in particular are at high risks due to irrational use of pesticides. Pesticides cause the acute and chronic health effects; organophosphate and carbamate groups are more important. These insecticides inhibit cholinesterase, an enzyme critical for normal functioning of the nervous system (Travisi&Nijkamp 1998; Gelman& Hill

In USA, more than 18,000 products are licensed for use and each year more than 2 billion pounds of pesticides are applied to crops, gardens, in homes etc. (U.S EPA 2002). The major economic and environmental losses due to the application of pesticides in public health were 1.1 billion dollars per year in USA (Pimentel 2005). Such wide spread use results in pervasive human exposure. Evidence continues to accumulate that pesticide exposure is as‐ sociated with impaired health. Occupational exposure is known to result in an annual inci‐ dence of 18 cases of pesticides related illness for every 100,000 workers in U.S (Calvert et al. 2004). Pesticide poisoning is a major public health problem in many developing countries (Xue et al. 1987; Jeyaratnam 1990). In developing world, pesticide poisoning causes more deaths than infectious diseases. Pesticide poisoning among farmers and occupational work‐ ers in developing countries is alarming (McCauley et al. 2006). WHO estimated approxi‐ mately 20,000 workers die from exposure every year, the majority in developing countries (Pimentel et al. 1992; Kishi et al. 1995). The number of intoxications with organophosphates is estimated at some 3000,000 per year and the number of deaths and casualties some 300,000 per year (Peter 2003). Ahmed and co workers have reported 64 percent of fatal cases of acute pesticides poisoning in Multan, Pakistan occurred due to Ops pesticide spraying (Ahmad et al. 2002; Ahmed et al. 2006) However another study revealed 21 percent of occu‐

Organophosphorous compound exert acute systemic toxicity by inhibiting the enzymes AChE through a process of phosphorylation. Pesticides bind to cholinesterase and block the hydrolysis of the acetylcholine and acetic acid at the post synaptic junctions without junc‐ tioning acetyl cholinesterase; acetylcholine accumulates (Chan &Critchley 1998; Mason 2000). OPs induced neuronal symptoms are a consequence of axonal death. Following OPs exposures inhibition of neuronal enzymes, called neuropathy target esterase, occurs and

pational pesticides poisoning in hospitalized patient (Afzal et al. 2006).

Health care providers are in an ideal position to identify and assess a patient's risk for expo‐ sure. The first step is to obtain an environmental history that covers residential and employ‐ ment histories, types of work activities performed currently and in the relevant past, and possible sources of exposure to biological or chemical agents. For each exposure source identified, additional information needs to be collected, such as frequency, duration, and in‐ tensity. Women who are pregnant or planning a pregnancy, especially those currently per‐ forming farm work, should be informed of the implications of exposure before, during and after pregnancy, and assisted in making decisions that are appropriate for their individual work and home situations (McDiarmid&Gehle (2006). In addition, providers should encour‐ age mothers to avoid exposure that might contaminate breast milk without unduly alarming them, perhaps by associating it with the importance of not smoking or drinking alcohol dur‐ ing pregnancy and nursing (Pohl &Tylenda 2000; Nickerson 2006). Of course, breast feeding should continue to be strongly encouraged since all evidence indicates that the known bene‐ fits far outweigh the potential risks (Eskenazi et al. 2006). Education about pesticide safety is an important measure for preventing exposure. The Migrant Clinicians Network has recent‐ ly developed a 14‐page full‐color Spanish language comic book and Wake Forest University School of Medicine has produced patient education handouts and posters in English and Spanish. Women living in farm worker households should be offered additional education on ways they and the farm workers with which they live can reduce take‐home exposure:


As the evidence continues to accumulate of the overall hazards that pesticides pose to hu‐ man health, it is important that health care providers consider the possibility and conse‐ quences of occupational, dietary and residential exposure to pesticides for their female patients. Occupational exposure is almost certainly the primary source of exposure for farm workers and their families (McDiarmid&Gehle 2006; WHO 2006). Awareness of the ways in which pesticide exposure occurs and the danger it poses are a crucial component of compre‐ hensive preconception and prenatal care for farm worker women.

Most of the units are seriously concerned with workers health issues. Generally, they have their own OHS plans and policies, which they endeavour to, implement and follow. Follow‐ ing OHS issues, which require more attention are identified because without following these practices a proper assessment of the workers exposure cannot be made:

