Original arh'cle KNOWLEDGE, ATTITUDE, AND PRACTICE (KAP) OF USING PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR CHILLIGROWING FARMERS IN HUARUA SUB-DISTFUCT, MUEANG DISTRICT, UBONRACHATHANI PROVINCE, THAILAND Saowanee Norkaewl, Wattasit Siriwongl,2, Sumana Siripattanakul3, and Mark Robson2~4~ College of mtblic Health Sciences, Chulalongkorn University, Bangkok, Thailand Thai Fogarty ITREOH Center, Chulalongkorn University, Bangkok, Thailand Faculty of Engineering and National Center of Excellence for Environmental and Hazardous Waste Management, Ubon Ratchathani University, Ubonratchathani, Thailand School of Environmental and Biological Sciences, Rutgers University, New Brunswick, N J , USA UMDNJ-School of Public Health, Piscataway, NJ, USA ABSTRACT: Pesticide use in Thailand has increased significant, raising concerns about potentially adverse effects on human health and environment, in particular, as a number of pesticide products have been heavily used on chilli farms The objectives of this study were: (1)to assess the knowledge, attitudes, and practices on using personal protective equipment (PPE) of chilli-growing farmers to protect themselves from pesticides, (2) to evaluate the knowledge, attitudes, and practices associated with pesticide use and exposure in the chilli-growing farmers, and (3) to provide recommendations and guidelines to reduce the exposure to pesticides among farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province, Thailand A standardized questionnaire was completed through face to face interviews with 330 chill-growing farmers The results showed that 53% of the participants were male and 39.6% and ages ranging between 31-40 years 71.2 % had received primary school education and most of them applied pesticides by themselves Almost 89.4% of respondents acknowledged that they ought to wear mask, boots, and cloth while spraying Furthermore, 83.3% knew that pesticides can pass through their body in ways; ingestion, dermal contact, and inhalation In addition, 45.5% of respondents knew that spraying should be done in the windward direction and that they should use PPE Many of the respondents checked their equipment before using them and wore clothing while spraymg Nevertheless, 77.2 % of chilli-growing farmers had low level of knowledge, 54.5 % of the farmers were not concerned about pesticide use or exposure, and 85.0 % of farmers demonstrated a fair level of actual usage The associations between knowledge and attitude, knowledge and practice, and attitude and practice demonstrated statistical significance with low positive correlation (0.216, 0.285, and 0.305 respectively,) The results suggested that government authorities and communities should be provided with the appropriate recommendations, strategies and guidelines to prevent adverse health effects regarding to pesticide exposure of farmers in this area Keywords: Knowledge, Attitude and Practice (KAP),Pesticide, Personal Protective Equipment (PPE),Thailand INTRODUCTION: Pesticides are widely used throughout the world, especially in agriculture for crop protection, especially within a n agricultural country s u c h as Thailand, Approxjmately 40% of the country's area is agriculture and comprises 60% of the total national workforce') In order to encourage agncultural production, farmers used large amounts of agrochemicals including fertilizers and pesticides T h d a n d h a s increased the amount of pesticides imported with approximately 21,000 tons in 1994 to over 80,000 tons in 2004 The majority of imported pesticides in recent years were herbicides, insecticides, fungicides, a n d plant growth regulators In Asia, Thailand ranked fourth in annual pesticide consumption The average pesticide use is very high and Thailand is the country with the thrd kghest pesticide use rate, following Korea and Malaysia21 Even though pesticides increases crop it has effects on human health An important problem related to agriculture is pesticide poisoning In 2008, highest number of illnesses was from pesticide * To whom correspondence should be addressed E-mail: wattasit.@chual.ac.th Tel 662-2188231 J Health Res 2070,24(~"pppi2): 93- 100 Original article poisoning and account for 79.63 % of total occupational diseases31 Health Systems Research Institute (2005) reported that Thai farmers are at risk due to pesticide poisoning because of inappropriate pesticide use, incorrect use of PPE and a lack of understanding regarding pesticide toxicity4) Normal misuse of pesticides usage included amounts or concentrations exceeding that recommended, mixing various pesticides together, inappropriate use of PPE while mixing or applying pesticides, improper disposal of pesticides, and a lack of awareness and knowledge Ubonrachathani Province is located in the northeast region of Thailand with average temperatures in the dry season (October to Apnl) of 24.69'C Of a total area of 16,112 km2, 10,577.66 km2 is used for crop cultivation and vegetations) Ubonrachathani produced various agricultural products such a s rice, cassava, c m , and rubber trees with a hgh usage of crop protection and cultivation agents6) The objectives of this study was to assess the knowledge, attitude and practice on using personal protective equipment, to evaluate the knowledge, attitudes, and practices (KAP) associated with pesticide use and exposure in cm-growing farmers, and to provide recommendations and guidelines to reduce pesticide exposure among chilli-growing farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province, Thailand MATEFUALS AND METHODS: This was a cross sectional study knowledge, attitude, and practice (KAP) of using personal protective equipment (PPE) among ch&-growing farmers in Huarua Sub-District, Mueang District, Ubonrachathani Province The study population was concentrated on farmers who use pesticides to control pest in chilli farms and included 330 farmers that apply pesticides on their farms The majority were farm owners that have controlled and mixed volume of pesticide and sprayed pesticide by themselves This study calculated sample size from population sizeq The farmers were selected by convenient sampling in this area; were more than 18 years of age, included men and women who were not pregnant The measurement tool used was by rno-g a standardized questionnaire that had been previously used among tangerine farmers in a pesticide safe use project89 9, ' ) It sought to assess the knowledge, attitude and practice on using personal protective equipment of chilligrowing farmers The questionnaire consisted of the following five parts: (1) socio-demographic characteristics, (2) information regarding J Health Res 20 10, 24(11tppI2): 93-100 pesticide use, (3) knowledge regarding use of PPE to limit pesticide exposure, (4) attitude towards pesticide usage and PPE,(5)practice on using pesticide and PPE RESULTS: The ages of participants ranged from 24 to 70 years old, with an average age of 42 years The majority of the participants were male (53.00%), couple (87.9 %), and head of family (51.5%) In this study, 71.2% of respondents graduated from primary school and 57.6% of the respondents had an income less than 50,000 baht Approximately 84.8% of the respondents were farm owner and 75.8 % of respondents owned less than rais or 1.19 acres of land Table demonstrates the general profile sample population Table 1: Socio-demographic characteristics Characteristics Number % Age (years) 30 35 10.5 1-40 130 39.6 41-50 105 1.9 51-60 40 12.0 >60 20 6.0 Mean SD = 42.0 + 10.7 Range= 24 to 70 Gender Male 175 53 Female 155 47 Marital status Single 35 10.6 Couple 290 87.9 Widow 1.5 Status in family Head of family 170 51.5 Spouse 110 33.3 Child 25 7.6 Parent 1.5 Occupant 20 6.1 Education Never 10 3.0 Primary school 235 1.2 Secondary school 50 15.2 High school 30 9.1 Bachelor's degree 1.5 Income (Baht/year) < 50,000 190 57.6 50,001-150,000 95 28.8 150,001-300,000 40 12.1 >300,001 1.5 land owner (1rai = 1,600 sqm2) < rais 215 65.2 3-5 rais 100 30.3 5-7 rais 15 4.5 Property relationship Owner 280 84.8 Renter/Employee 50 15.2 Original article When examining problems that respondents encountered during growing crops, 84.8% listed insects as the main problem, flowed by weed (60.6%)and plant disease (74.2%) Furthermore, 47% of participants claimed that they applied abamectin, 23.3% applied selecron (profenofos), and 14.9% used podium600 (chlorpynfos) 14.9% to their crop Typical pesticide applications included self-spraying (81.Bolo) Although 77.3% of the respondents claimed that they did not have any chronic diseases, when assessing symptoms associated with pesticide use, results revealed that 57,6% never showed any symptoms while 39.4% showered few symptoms of headache, fatigue, dizziness, stomach cramps, and throat irritation In addition, 48.5% of respondents claimed that in the past 12 months, they had taken a cholinesterase test with normal results while 34.8% had never checked Furthermore, when farmers felt dl from pesticide use the same amount of participants went to health centers a s relied on themselves (23.3%).On the other hand, 20% of respondents went to district hospital and alternative medicine Participants typically obtained information regarding pesticide use from agricultural officer ( 17.89%) or television (15.75%) Table demonstrates mformation regarding problems of weeds, insects, and pesticide use Table 2: Information regarding problems of weeds, insects, pesticide use of participants Characteristics Number % Insect problem Yes 280 84.8 No 50 15.2 Weed problem Yes 200 60.6 No 130 39.4 Plant disease problem Yes 245 74.2 No 85 25.8 Animal problem Yes 15 4.5 No 315 95.5 Common pesticide used Abamectin (abamectin) 155 47.0 - Characteristics Selecron (profenofos) Podium 600 (chlorpynfos) Paraquat (paraquat) h a t e (carbamate) Other Pesticide Application* Apply by self Apply by hired applicator Congenital disease Congenital disease Never Toxicity symptom Never Few symptom Moderate symptom How to treat Toxicity symptom associated w i t h pesticide* By themselves Herbal use by themselves Alternative medicine Health center Private clinic District hospital Provincial hospital Snxce of pesticide inf~~nation* Radio TV Document/ article Broadcast tower Neighbor Agricultural office Public health office Pesticide salesman Community header Health volunteer Have you had a cholinesterase test in the last 12 months? Never Yes but not know result Yes and normal Yes and not normal Yes with health effects 77 49 30 10 270 % 23.3 14.9 9.1 3.0 2.7 60 81.8 18.2 75 255 22.7 77.3 190 130 10 57.6 39.4 3.0 77 62 27 77 18 32 37 23.33 18.79 8.18 23.33 5.46 9.70 11.21 41 52 42 28 33 59 48 13 12.42 15.75 12.72 8.48 10.00 17.89 2.12 14.56 2.12 3.94 115 20 160 30 34.8 6.1 48.5 9.1 1.5 *multiple choices The average knowledge score among respondents was 6.48 (SD=2.64)whereas scores ranged between to 11 with 70% of respondents receiving scores ranging between to The item with the highest amount of correct responses was to the question, 'When you were spraying pesticide, what is the proper practice?" in which 89.4% respondents recognized that they should use mask, wear boots, and wear proper attire that covers their body entirely Many respondents (83.3%) knew that the pesticides can pass through their body J Health Res 20 10,24(Sz,~pI2): 93-I00 Original article Correct via routes; ingestion, dermal contact and inhalation About 71% of respondents knew that the pesticides were contaminated and accumulated in soil, water, air and vegetables that were sprayed Furthermore, they were - aware that long term pesticides exposure symptoms causes dizziness and feel dry (60.6%) More than half of them (57.6%) followed the recommended amount when spraying pesticides, cleaned equipment with detergent, showered and immediately changed their clothes after pesticide spraying In addition, 47% of respondents were concerned about the manufacturer and expiration dates, selecting pesticides based on the desired type of pest erahcation Approximately, 26% of them knew that pesticides were hannful to all living things and were aware that drinking pesticides by accident could cause vomiting About 20% of them knew about the toxicity and harmfulness of pesticides based on the colors used on pesticide labels, keeping pesticides separately in a locked cabinet L~~~ than 20% mixed I J Health Res 2010, 2J(supp/ 2): 93- I00 235 71.2 '10 200 60.6 190 57.6 85 25.8 The results demonstrated that 77.2% of respondents had a low level of knowledge, 22.8% of them had a moderate level, while none of the farmers demonstrated a high level of knowledge of using PPE The results can be found in Table Table 4: Distribution of knowledge levels of using PPE Knowled e level Low level (160%) Moderate level (60%-80%) Hi level 81%- 100°h to table 5, appmximately 38% of respondents considered pesticides harmful to human health and the environment They believed that exercise could help excrete toxic pesticide :: zB 8.iir~imgWhmisthepest1dde Number *negative statement pesticides in container before filling spraying machines In addition, they disposed of empty pesticide containers by throwing them away in local waste bins Table demonstrates the number of percentages of participants responses regarding knowledge o pesticide usage Table 3: Number and percentage of knowledge Correct Knowledge items Number % How many routes that the mcides 275 83.3 canpassthroughthebody?What? I 2: What is dkadmntage of pestkdeuse? How to use the pesbcide properly? 155 47 When you want to buy W d d e , How you consider? How to known toxicityof Wcide? 70 21.2 What is the axrect method of ~ 57.6 Wcide use? I 60 18.2 How to proper mix of pesticides? residual? When you we^ sprayingpesbdde, What is the pqxrly practice? 10.What are the pmperly practices afkr @dde used? 11 How to storage the peshcide product? 12 How to diof emptyMcide containers? Knowledge items 13.Whatisthesymptomoflongte1m dcidem? &dice the jirst aid in case of acute mcide? 15.Howto~cesthefirstaid + , i,,,ofdrinkdcide? 1 through sweat while 34.8% were unsure of whether dnnlang water after exposure could help in the same way m e r m o r e , 26% of respondents stated that using wmd ~ c tok pesticides Mg was safer than using their hands and 45.5% of respondents believed that spraying should be done in the windward direction In addition, 40.9% knew that they should use PPE during spraying and 36.4% of respondents believed that they if used more than the recommended amount of pesticide whde spraying that it would increase their crop yield Approximately 33% were disagreed that pesticide can pass through the body only ingestion 30.3% of them agree that mticide is harmful to insect onlv Less than 30% of the respondents were considered with after spraying A without wearing- -protective equipment must take a - shower as a preventive alternative Less than 30% of 75 22.7 50 15.2 the respondents believed that showering was a good preventative alternative after spraying pesticides without wearing PPE Less than 60% of them usually wore boots whde spraying Original article Table 5: Percentages of attitudes towards using PPE of each SLronghl Attitudeitems 1.M d d e canpass through the body only lngeston route * RsticideMtoinsectonly,nothannfulto human health* Incxax amount of w d d e anyhme of u x to preventhce* Mix various e c i d e s will incmx effectiveness and no d i m * Using w o o d - M to mix the pesticides is safety than using hand Usepesbcides more than label mommendation may incmx yield* Ifyou stand windwad directon when spraying pesticide, donL concern about clothes* Mcides arehamf~~I to the human health and environment Drink coconutjuice after e x p a d m c i d e for exaetmg m d d e toxicity* 10.Drink water after e x p & &ride f a exaebng pesbcide toxicity' 11 Exerrise can help to excreting pesbcide tcwcity throughsweat 12.While you arc sprayingpeshcide, you should not wear Cl0thE-gthoroughly * 13.Pesticide can residues in a@prcck~ctand its harm to c a x m m e r 14.~sivechemicalsare~ectivetocontrolpest Agree ape Neutd Di=P= Strongty Yo Yo 0x7 Yo Yo 9.1 22.7 16.7 33.3 18.2 bettesthancheapchemicals* 15.If sprayingchemical without wearingp r o t h e equipment,must shower immediately afterthe spray as a ureventive alternative* *negative statement Table demonstrates attitudes towards PPE use.54.5% of respondents were not concerned about using PPE, while 45.5% had a neutral attitude towards PPE use Table 6: Distnbution of attitude levels towards PPE Attitude level Concern Attitude (81%-100%) Neutral Attitude (60%-80%) Not concern Attitude 54.5 Less than 60% Table Illusbates the respondents took showers immedBtely after spraying 75.8% and 74.2% of the washed their hand and face with soap after using pshcides prior to eating Appmumately 68% of respondents checked eq~~pment pnor to use and 63.6O/0wore clothes that c o d their entire body Also 62.1% d d not allow other people or other ammals to be in the vicinity while spraying Wcides Less than W ! of respondents removed their clotlvng or shoes immediately afler spraying More than half of respondents usually read the instructions on use prior to use and followed the m m e n d a t i o n s , wore gloves and a mask when mixing pesticides, and burned or buried the empty pesticide oontainers aflerwards Less than half of respondents took the time to learn about appropnak type of e c i d e to use, washed the clothes they wore during wearing spraylng irnrndtely & d s , and stocd in the windward direcbon while spraying yet without wearing PPE Apprmbately 30% of respondents used detergents to clean their phcide containers and 59.1% of respondents h e d to have never mated m c i d e s using their bare hands In addtion, 53% of respondents had never smoked or drank water whde spraying pesticides Half of the d spray pest~cideswhen the weather respondents d ~ not was windy Less than 550%of respondents threw empty pesticide containers into a river or resen& Appnximately Wh of respondents dmany types of pesticides together in order to increase effdheness J Health Res 20 10, 24(supp~2): 93-I00 Original article 98 Table 8: Distribution of practices towards using PPE Table 7: Percentages of practice towards using PPE Practice level Good practice (81%- 100%) Fair practice (60%-80%) Poor ractice Less than 60% of pesticide 2.Selectpesticide by L, Variables Knowledge & Attitude 59.1 4.8 1.5 28.8 9.1 19.7 12.1 33.3 28.8 53.0 50.0 14,Standwindwddirecdon 18.2 while spmyh.1g with out probxtiw equipment* 19.7 36.4 25.8 k W I containers m the river after used* 1.5 27.3 242 47 25.8 30.3 18.2 25.8 59.1 27.3 10.6 3.0 47.0 28.8 13.6 10.6 27.3 22.7 21.2 28.8 51.5 33.3 4.5 10.6 74.2 22.7 1.5 1.5 75.8 21.2 1.5 1.5 used* 17.Cleaningpesticide applicators WithdeteIgent before storage 18.RaM-xle&thswhich when spraying irnmdateb 19.Washing&thswhile we;uing spray immdteiy 2O.Storagepzitlcides in cabinets Ernpy pesticide containersshould be burned or buried 22.Wash handandwash hewith soup befm having meal 23 Shmimm&teiy Spearman's rho Coefficient 0.2 16* howledge & Practice 0.285" Attitude & Practice 0.305* * Correlation was at 0.0 level of significance tho mu^ 16.Dhsp3sepestic.de coniainen m the w after 85 Knowledge, attitude and practice q a d m g use of PPE were anaIyzed using Spearman's rank correlation d c i e n t s The assmiation between howledge and attitude, knowledge and pracbce, and attitude and practice demonstrated a low posltive correlation (0.216, 0.285, and 0.305 mqxdnely) W e 9: Asmiation among knowledge, attitude, and mctice ofusing PPE n@tor's xrmmmendd/ alhrhmg/price* 3.Read label before use and fobm e n d a h 4.Checkequipmentand material before using 5Avodd human and animalhmsprayingam 6.WeargloJesandmask whenmxingpesticides 7.Inhalepesticide for confirmingpestidde* a pesticide by hand* a various pesticidefor maease decfive radiation * 11.Wearboot 12.Smo~ordnnkmg* wpesticide ~ while 180 30 aflersprzlly *negativestatement Table showed the distributions of practioes of -dents in uslng PPE While 20% demonstrated god practice, 85%showed f;3ir practice, and finally 6% had p r practice J Health Res 20 10,24(suppl2): 93- 100 Discusion: In this study, the results showed that 53% of the p a r h c i p t s were male with the average age of 42 years More than 70% of respondents were h m 31 to 50 years and most of them were head of hndy and f m owner These findings are sirmlar to other research that demonstrated that the average age was 43.6 years and 58.4% of the parhcipants were between the ages of 31 to 50 years old and were farm owners Other research also revealed that the age range of people w o r m in cottage industries was between 25 to 40 years77 11) In general, there is a qqlicant difference of F c i d e use between male and fernalel1).In this study, 71.2 % of respondents d e d primary school education, which was in amrdance with a study conducted in Braal where 83.2% of workers had less than years of education? Aim, in another research study underkiken in Nepal data revealed that most of farmers had less than years of education@.The popular pesticides used were a b a m d , profenofos and chlorpydios The main problem that farmers encountered was insects (84.8%) Other studies in Thailand found most h e r s used m c i d e s and the most common used were herbicides and insecticides (ch1opynfos)q Another study reported that about 92% of the inMewees had worked directly with pesticides? Similarly, 81.9% of f&mers were mixing and s p y i n g pesticides by themselves A study in Lebanon found that a g r i c u l t u d workers received information x g x c h g F c i d e s through oml communication and had poor protective measureslq Original article In this study, the majority of dormation about pesticides was obtained through i n f d sources such as agncultural officer (17.89%) and television (15.75O),whch is in a m d a n c e with a similar study in the field of cottage industries1? Th~sstudy found that 89.4% wore masks, protective clothmg and boots, which is slrmlar to another study in Ethiopia that showed that PPE was commonly used on farmsl9 On the other hand, a study in Nepal reported that more than half of the fanners d ~ dnot have knowledge regardug PPE1ll Also, 83.3% mgmzed that the pesticide could be absorbed in three different ways and was typically through occupational exposure@ Most of respondents were aware that W c i d e s could be accumulated through soil, water, air and plants, whlch was relatively amsistent with a study h m Gaza Strip@.In addition, more than half of respondents followed directions of pesticide labels, showered and changed imrnedmtely after spraying pesticides, whch was in accordance with research undertaken in B d that found that most farmers showered after working with W c i d e s and followed label instructions as we117; however in Nepal,half of respondents did not shower after spraying and a third wore the same clothes more than once while spra$ngl1).Approximately one- quarter of respondents knew the pesticides were harmful to all h g thmgs, which is dissirmlar to other studies7 11, Q Only few respondents knew that the type of pesticide they should use depends on the type of pest they are atternptung to combat In Nepal, nearly 800/0 of respondents decided themselves on which pesticides to use and more than 70% had low level of knowledgell].This was relative with another study in Brad whlch found that growers used highly toxic insecticides7 In addition, respondents considered pesbcides to be harmful to their health and to the environment, whch was consistent with other studies7, 11,12) Attitude regadng spraying pesticides was similar to a study in Brad wherein farmers were observed and sprayed pesticides in the same direction as the wind73 111 Also, a study undertaken in the Gaza strip reported the symptoms associated with toxic pesticide exposure among farmers were related to concentration of m c i d e s usedo Most of respondents mmgmed that pesticides could pass through the body in other ways other than ingestion, such as through dermal contactand mhalationl3 For attitude towards wearing p r o t e e clothu~gfarmers were not aware that h s was necessary, whch agreed with a study in Ethiopia that reported that respondents were careful wMe working with pesticides, which they believed to be more important than using PPEl9 The respondents chmed that showering would remove pesticides b m contammated body surfaces and most of them did showering afterw o r h g with pesticides7,19 Respondents d ~ d not demonstrate much concern regardug pesticide use and exposure This similar to other studies done in Gaza Stnp that reported that farm workers had misconceived notions rgardmg pesticide use and it was h ~ t h e that d this was the cause of decreased PPE use*, 1% Another study in Thailand reported that less than half of farmers used PPE whde spraying psbcides, washed their hands, showered, or laundered their clothes after ~praymg9~111 In southern Brad, it was reported that over 50% of the agticulkmd workers used protective equipmentl6) More than half of respondents d ~ dnot smoker drink water while spraying pesticidesl1 '3 In terms of the practice of appropriate methods while spraying pesticides, 85% demonstrated a fair level of proper practice Some studies in developing countries were similar, especially with qp-ds to protective q p m e n t Q The hgh cost of PPE was mentioned as an important factor in the limited use12, 1S.The association between knowledge and attitude, knowledge and practice, and attitude and practice demonstrated little positive correlation Conclusions and recommendations: The results revealed that respondents received primary school education; most of them owning the properties where they worked and used pesticide dmxtly Common pesticides used during growing season were ah&, pfmofos and chlorpynfos Typically, respondents received health care services h m a health center and obtained information regardmg pesticide use from agricultural officer A majority of them knew to use PPE and the routes that psbcide can be absorbed into the body Most of the respondents demonstrated a low level of knowledp regardug PPE and pesticide use, were mostly not concerned about it, and demonstrated a Ewr level of practice in terms of using PPE Therefore, evidence- based methods should be developed that can assess the occupational health risk J Health Res 20 10, 24 (~rippI2): 93- 100 Original article assodated with pesticide use The intervention tools should be developed for enhancing suitable practice for PPE usage and to improve the accuracy in the information given Farmers should be trajned in the proper usage of personal protective devices Based on these lindmgs, appropriate policy should be created in order to increase the knowledge regding the harrml effects of e c i d e s and the importance of using PPE at work Therefore educational programs should be orgamed to increase awareness by h o l m bahhgs as well as dstributmgliterature regardmg PPE and the hazards of pesticide usage among farmers Acknowledgement: We would like to thank Thai Fogarty Center (Grant Number D43 TWO07849 Fogarty International Center - National Institutes of Health) for fhll rexarch support And we are appreciated with Dr Srilert Chotpantarat for field support Reference: National Statistic Office of Thdand 2008 Key statistics of Thailand Ministry of Information and Communication Technology Available fi-om: http: / /www.nso.go.th [Access on October 16, 20091 Panuwat P, Prapamontol T, Chantara S, Thavomyuthkam P, Montesano AM, Whitehead JR, et al 2008 Concentrations of urinary pesticide metabolites in small-scale farmers in Chiang Mai Province, Thailand Science of the total environment 407: 655668 Division of Epldemiolqy 2208 Annual epidemiological surveillance report Available h m : http://203.157.15.4/Annual/Annua1%202 55 1/ Part2-5 1/AnnuaLMenuPart2-5 1.html [Access on November 7, 20091 Health Systems Research Institute 2005 The situation of pesticide usage in Thailand Final report 54 pp Topography of Ubonratchathani Province 2008 Database on Topography of Ubonratchathani Province Available f?om: http: / /www.ubonratchathani.go th/lectureubon5 1/ 1.ubontopography.pdf [Access on September 18, 20091 6.AgnculW &tension m c e of Umnmtchathani l'rovince 2008 Database on Economics of Ubmatchathani Pfuvince Available ihn http: / /www,ubonratchathani.go.th/lecture~ ubon5 1/4.ubon-econornic.pdf [Access on September 18,20091 Recena PCM, Caldas DE, Plres XD, Pontes CJE 2006 Pesticides exposure in J Health Res 20 10, 24(~tpp(2):93- 100 Culturama, Brazil - Knowledge, attitudes, and practices Environmental Research 102: 230236 Jaipieam S 2008 Risk assessment of multi-route exposure to organophosphate pesticide if vegetable growers (A case study at Bang Rieng Sub-dstrictt, Khuan Nieng Districtt, Songkhla Province) The Degree of Program in Doctor of Philosophy Envirbnmental Management, Graduated School, Chulalongkom University Sematong S, Zapumg K, Ktana N 2008 Pesticide use, farmer knowledge and awareness in Thong Pha Phurn region, Kanchanaburi Province Journal of Health Research 22(1):15-20 10 Sinhaseni P, Pittiyanuwat S, Boonlue T, Uwanno T, Sirisingh S, Winotai A, et aL 1994 Pesticide safe use training: Tangerine growers in Thailand Chulalongkom University 11 Yassin MM, Abu Mourad TA, Safi JM 2002 Knowledge, attitude, practice and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip Occupational and Environmental Medicine 59: 387-394 12 Atreya K 2007 F'esticide use knowledge and practices: A gender differenin NepaL Environmental Research 104:305-311 13 Salameh RP,Baldi I, Brochard P, Saleh AB 2003 Pesticides in Lebanon: a knowledge, attitude, and practice study Environmental Research 94: 1-6 14 Ignatius TSY, Nga LL, Wang TW 2005 Knowledge, Attitude and Practice Regarding Organic Solvents among Printing Workers in Hong Kong Joumal of Occupational Health 47: 305-310 15 Mekonnen Y, Agonafir T 200 Pesticide sprayers' knowledge, attitude and practice of pesticide use on agricultural farms of Ethiopia Occupational Medicine 52: 11-3 15 16 Faria NMX, Facchini LA, Fassa AG, Tomasi E 2000 The rural labor process and health in the Southern Branlian Mountains: a descriptive study Cademos de Saude Pitblica 16: 115-128 ... Distribution of practices towards using PPE Table 7: Percentages of practice towards using PPE Practice level Good practice (81%- 100%) Fair practice (60%-80%) Poor ractice Less than 60% of pesticide... Mueang District, Ubonrachathani Province, Thailand MATEFUALS AND METHODS: This was a cross sectional study knowledge, attitude, and practice (KAP) of using personal protective equipment (PPE) among... 85 Knowledge, attitude and practice q a d m g use of PPE were anaIyzed using Spearman's rank correlation d c i e n t s The assmiation between howledge and attitude, knowledge and pracbce, and