Comparison of AChE level with working years.

An estimated 69% of the population of Bhutan is engaged in agriculture. Farmers are exposed to a wide variety of pesticides during the preparation, transport, storage, mixing and application of pesticides posing a significant health risk. A controlled cross-sectional study of farmers in selected sites of Bhutan was conducted to characterize the level of exposure to pesticides and assess their knowledge attitude and practice on the safe handling of pesticides. A total of 399 participants were enrolled in the study comprising of 295 exposed farmers and 104 healthy and unexposed controls. A structured investigator administered questionaries was used to assess their Knowledge, Attitude and practice, and their blood samples were taken for measuring Acetyl Cholinesterase enzyme activity level. There was a significant difference between the Acetyl Cholinesterase enzyme inhibition of exposed and non-exposed control groups observed in the study (P 30% as compared to the unexposed group. Safety practices of handling pesticides were low. The most common symptoms self-reported were headache (OR 1.08, 0.60–1.93) and neurological problems like forgetfulness, lack of concentration (OR 1.12, 0.50–2.48) and increased tiredness (OR 1.075, 0.52–2.19) that were significantly associated with the enzyme inhibition. In addition, we record a very low level of knowledge (17.0%), a fair attitude (63.0%) and poor practice (35.0%) on the safe handling and management of pesticides. This pilot study provides indication of exposure to pesticides in the selected sites of the country. Furthermore, it provides evidence for public health interventions by identifying the exposure patterns and pathways of individuals most at risk in the farming communities of the country. Surveillance and bio-monitoring programs are deemed necessary.

据估算，不丹69%的人口从事农业生产。农民在农药的配制、运输、储存、混合与施用过程中会接触各类农药，这将带来显著的健康风险。本研究针对不丹部分选定区域的农民开展了一项对照横断面研究（cross-sectional study），旨在明确农民的农药暴露水平，并评估他们在农药安全操作方面的知识、态度与实践（Knowledge, Attitude and Practice, KAP）。研究共招募399名参与者，其中包括295名暴露组农民与104名健康未暴露的对照组个体。本研究采用调查员实施的结构化问卷评估参与者的知识、态度与实践，并采集血液样本以检测乙酰胆碱酯酶（Acetyl Cholinesterase）的活性水平。本研究观察到暴露组与非暴露对照组的乙酰胆碱酯酶抑制水平存在显著统计学差异，暴露组的酶抑制率较未暴露组高出30%。此外，农民的农药安全操作合规率较低。参与者自我报告的最常见症状包括头痛（比值比OR=1.08，95%置信区间0.60–1.93）、健忘、注意力不集中等神经系统问题（OR=1.12，95%置信区间0.50–2.48）以及疲劳加剧（OR=1.075，95%置信区间0.52–2.19），上述症状均与酶抑制水平显著相关。同时，研究发现参与者对农药安全操作与管理的知识掌握度极低（17.0%）、态度尚可（63.0%）、实践操作欠佳（35.0%）。这项初步研究证实了不丹部分选定区域存在农药暴露情况；此外，本研究通过明确该国农业社区中高风险个体的暴露模式与暴露途径，为公共卫生干预措施提供了依据。因此，建立监测与生物监测计划被认为是必要的。