Epidemiology of Acute Pesticide Poisoning in the Philippines Dr. Lynn R. Panganiban National Poison Control & Information Service U.P. Manila

FACTS & FIGURES Important health problem Incidence is 32% of all poisoning cases 795 registered pesticides (FPA, December 31, 2001) Filipino farmers use ten times more pesticides as required. 1987-1989, the major pesticide companies put on the market 20,100 tonnes of pesticides Sales of pesticides have increased by 70% between 1988-1992 1998 total crop protection market amounted to P 4,794 M (US$ 96 M) FACTS & FIGURES

Castaneda, CP; Maramba, NPC. A Three-Year Retrospective Study of Acute Poisoning due to Anti-cholinesterase Insecticides (1974-1977) Incidence of Insecticide Poisoning According to Specific Anti-Cholinesterase Agent and Their Toxic Rating (n=25)

NUMBER OF PESTICIDE POISONING Incidence rates of pesticide poisoning SOURCE YEAR NUMBER OF PESTICIDE POISONING INCIDENCE RATE (per 100,000) Department of Health (12 regions) 1982-1985 1,704 3.27 NPCIS National Capital Region 1986-1990 221 2.6 Region XI 166 4.08 (6 regions) 1991-1995 333 1.08

National Pesticide Safety Type of pesticide and case fatality rate, 1982-1985, Department of Health National Pesticide Safety Program, 1979 (FPA) aIncludes organophosphate and carbamate, organochlorine and organophosphate, organophosphate and pyrethroid, etc. b Includes potassium nitrate, plant regulator, urea, etc.

DEATHS: Monocrotophos 6 Type of pesticide and case fatality rate, 1991-1995, Department of Health TRAINING WORKSHOPS BANNING/RESTRICTIONS ANTIDOTE PROCUREMENT TREATMENT ALGORITHM Endosulfan 33 DDT 1 Unspecified 15 Monocrotophos 14 Piperophos 7 Malathion 6 Bionex 3 Diazinon 2 Chlorpyrifos 1 Ethyl azinphos 1 Methylparathion 1 Unspecified 180 DEATHS: Monocrotophos 6 Methylparathion 1 aIncludes organophosphate,carbamate, and pyrethroid

Type of pesticide & case fatality rate, Department of Health Type 1982-1985 1991-1995 Organophosphate 42.0% 64.6% Organochlorine 19.1% 14.7% Pyrethroid 1.2% 8.1% Type CFR 1982-1985 1991-1995 Organophosphates 16.2 19.1 Organochlorines 49.4 32.6 Pyrethroids 0.0 3.7

To estimate the extent of human pesticide Pesticide poisoning in selected hospitals in four regions in the Philippines, 2000-2001 Pesticide poisoning in selected hospitals in four regions in the Philippines General Objective : To estimate the extent of human pesticide exposure and poisoning in selected areas of the Philippines with a view to implement preventive and education strategies to reduce morbidity and mortality from pesticide poisoning

Specific Objectives : To prepare and maintain a database on pesticide poisoning cases with reference to : - type of pesticide - circumstances of poisoning - main population group affected based on data gathered from regional, provincial and district hospitals in selected regions in the Philippines To identify the main products involved in human pesticide exposure in relation to geographical/agricultural characteristics of the area

Specific Objectives : To publish and disseminate the results of the studies To set the basis for recommending and planning prevention and education activities in cooperation with other planners To contribute to the regional and global components of the project

Pesticide poisoning in selected hospitals in four regions in the Philippines April 1,2000 - March 31, 2001 Luzon: Region II, CAR Visayas: Region VI Mindanao: Region XI Pesticide Exposure Record (IPCS) Number of hospitals: Region II: 7 CAR: 9 Region VI: 7 Region XI: 15

Pesticide poisoning in selected hospitals in four regions in the Philippines Sex and Age Distribution N=327 174 males : 152 females Mean age: 28.2 + 14.2 years (1 year old - 83 years old) 25.4% in the 16-20 age group 20.7% in the 21-25 age group

Pesticide poisoning in selected hospitals in four regions in the Philippines N=327

Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticide poisoning in selected hospitals in four regions in the Philippines Circumstances of Exposure

Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticide poisoning in selected hospitals in four regions in the Philippines Location of Exposure

Pesticide poisoning in selected hospitals in four regions in the Philippines Malathion 22 Chlorpyrifos 14 Diazinon 11 Ethofenprox 3 Methamidophos 2 Oxadiazon 2 Dimethoate 1 Edifenphos 1 Methyl parathion 1 Monocrotophos 1 Triazophos 1 Cypermethrin 60 Deltramethrin 12 Lambdacyalothrin 12 Cyfluthrin 2 Fenvalerate 2 Hexythiazox 1 Endosulfan 8 Aldrin 1 aIncludes organophosphate and carbamate, organochlorine and organophosphate, organophosphate and pyrethroid, etc.

Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticides Used according to FPA Category Classification

Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticide poisoning in selected hospitals in four regions in the Philippines Actual Use of Pesticides

Pesticide poisoning in selected hospitals in four regions in the Philippines Severity of Poisoning

Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticide poisoning in selected hospitals in four regions in the Philippines Clinical Manifestations: Vomiting is the most common finding Diarrhea : anticoagulant, zinc phosphide, organochlorine Seizures: organochlorine, aniline Coma: organochlorine, aniline Drowsiness: carbamate, aniline, organophosphate

Treatment Pesticide poisoning in selected hospitals in four regions in the Philippines Pesticide poisoning in selected hospitals in four regions in the Philippines Treatment

Pesticide poisoning in selected hospitals in four regions in the Philippines Utilization of Atropine by Chemical Class

Duration of Hospital Stay

Pesticide poisoning in selected hospitals in four regions in the Philippines Outcome of Poisoning

Pesticide poisoning in selected hospitals in four regions in the Philippines Chlorpyrifos 3 Malathion 2 Methyl parathion 1 94.4% of deaths: severe aIncludes organophosphate and carbamate, organochlorine and organophosphate, organophosphate and pyrethroid, etc. b Includes potassium nitrate, plant regulator, urea, etc.

Pesticide poisoning in selected hospitals in four regions in the Philippines Mortality Rates

Observations /Trends : Pesticides still in the top 10 poisons Incidence rate : 1-5/100,000 population Shift in the type of pesticides Shift from Category I to Category III/IV Type of pesticides vary from region to region

Observations /Trends : Agricultural versus household pesticides Intentional cases versus occupational/accidental Decreased case fatality rates

Observations /Trends : Despite interventions: organochlorines still the #1 cause of mortality availability of banned/restricted pesticides errors in management

Thank you and good day.