Pesticide Exposure and Neurobehavioral Performance among Paddy Farmers

Abstract

The study aims to assess the potential risks and impacts of pesticide exposure on paddy farmers. Specifically, it focuses on evaluating the knowledge, attitude, and practices of these workers regarding pesticide exposure, as well as determining their neurobehavioral performance. This study adopted a questionnaire on knowledge, attitude, and practice and the workers were interviewed for their demographic information, health symptoms, and chemical exposure factors. The Neurobehavioral Core Test Battery assessment tools were used to evaluate neurobehavioral performance. About 43.9% of respondents had high knowledge of the pesticide used, 53.7% of them showed a concern level of attitude toward pesticide usage, and 68.3% of them indicated good practice while handling the pesticide. 48.8% of the workers showed underperformed neurobehavioral performance. The chi-square test revealed significant associations between neurobehavioral performance and spraying frequency (p = 0.005) and frequency of changing personal protective equipment (PPE) (p = 0.05). Overall, the study seeks to shed light on the level of risk, knowledge, attitudes, and practices among paddy rice workers regarding pesticide exposure. This information can guide the development of interventions and strategies to promote worker safety, minimize pesticide-related risks, and protect both human health and the environment.

1. Introduction

Pesticide is the most common and widely used in agriculture work which gives many benefits to the crops by giving high product quality yield and helps in preventing and controlling pests from causing any damage to the crops. The term pesticide covers a wide range of compounds including insecticides, fungicides, herbicides, rodenticides, molluscicides, nematicides, and others [1]. Pests, weeds, and plant diseases are responsible for considerable yield loss of various crop production in tropical Asian countries. World Health Organization (WHO) defined pesticides as chemical compounds used to protect crops from pests and plant diseases as well as to control weeds [2]. Based on statistical data, there are nearly 2.7 million metric tons of pesticides globally used in 2020 [3]. Malaysia itself recorded the usage of 44.1 thousand tons of pesticides in 2018, mainly on paddy, rubber, vegetables, fruits, and palm oil plantations [4]. Farmers, agricultural workers, and pesticide operators, in most parts of the world, were exposed to high incidences of poisoning and health hazards due to working with chemical pesticides in the past [5, 6]. Pesticide exposure was shown to correlate with adverse health effects, such as vomiting, diarrhea, skin irritation, and dizziness [6]. Various factors can impact the extent of pesticide exposure in real-field settings. These factors encompass the kind of crop cultivated, the specific pesticide utilized along with its physical and chemical characteristics, the spraying machinery employed, the adoption of personal protective gear, storage practices for pesticide products, proper disposal of empty containers, and the behaviors and expertise of those working with these substances [7]. Toxic chemical from pesticides gradually accumulates in body fat through dermal, oral, and respiratory routes due to improper handling, and it may pose long-term and chronic effects on human health [8]. On the other hand, it was estimated that 6.7% of agricultural workers in Malaysia are poisoned each year [9]. According to the report by the World Health Organization and the United Nations Environment Program, there are over 3 million chemical poisonings reported annually and 200,000 pronounced deaths worldwide due to pesticide exposure [10]. Chemicals also can alter neurobehavioral performance. Beyond the age of 28, there is a decline in nerve function every 5 years. This decline is attributed to the impact of harmful chemicals from pesticides, which can enter brain cells through various biological mechanisms. Consequently, nerve cell deterioration occurs, resulting in altered neurobehavioral functions [11]. The previous study has indicated that pesticides can lead to changes in neurotransmitter systems, ion channels, mitochondrial function, cholinergic mechanism, and free radical production, all of which contribute to impaired neurobehavioral functions in individuals. Furthermore, individuals with abnormal nutritional status have been found to exhibit poorer neurobehavioral performance compared to those with adequate nutritional conditions, likely due to endocrine disruption [11].

Moreover, previous studies highlighted the significant influence of insufficient training or education when handling pesticides. Despite the Malaysian government offering free certification in Good Agricultural Practices (GAP) to promote sustainable farming methods, there is a low uptake among rice farmers in obtaining MyGAP certification. Consequently, this low certification rate contributes to a decrease in the percentage of farmers adopting safe agricultural techniques for their crops [12]. Furthermore, providing comprehensive guidance to farmers regarding the use of chemical pesticides is crucial in mitigating the adverse effects of rice farming practices on human health, environmental impact, and the sustainability of paddy cultivation techniques. Besides, a study conducted in Bangladesh revealed that trained farmers, in contrast to their untrained counterparts, demonstrated increased adherence to safety protocols during pesticide handling [13]. This included actions like properly covering their bodies, changing and washing contaminated clothing used during spraying, and taking a bath after completing pesticide application. Delivering comprehensive training regarding pesticide knowledge, attitudes, and safety measures can positively impact both workers and the environment. Malaysia has prioritized its self-sufficiency policy concerning rice and paddy production. Throughout the Eleventh Malaysian Plan (2016–2020) and the National Agro-Food Policy (2011–2020), Malaysia has consistently implemented proactive and forward-thinking strategies to foster the growth of its paddy and rice sectors [14]. In Malaysia, paddy holds utmost significance within the food subsector for two primary reasons. Firstly, rice stands as the staple food for the majority of the population, with Malaysian adults consuming an average of 2.5 plates of white rice daily [15]. Secondly, within the paddy farming community, the crop serves as the primary source of income and sustenance, especially for small-scale farmers and landless agricultural workers. A study conducted in Kelantan revealed that it is the second state with significant granary areas in Malaysia, following Kedah. The Kemubu Agricultural Development Authority (KADA) was established in 1968 as part of the concerted efforts to bolster national food security and achieve self-sufficiency, aligning with the objectives outlined in the Agro-Food Policy (2011–2020) [16].

Evaluating the knowledge, attitude, and practice (KAP) regarding pesticide use among paddy farmers holds immense importance. This study seeks to gauge the KAP levels specific to this group, serving as a baseline dataset. The insights garnered aim to pinpoint interventions capable of improving farmers’ KAP. Furthermore, the study outcomes could aid governmental agencies in understanding the KAP of paddy farmers, facilitating the development of more impactful training and educational initiatives tailored to this demographic.

2. Methodology

This cross-sectional study focused on paddy farmers in Kota Bharu district, Kelantan who utilized chemicals in their agricultural work. The inclusion criteria encompassed paddy farmers aged 18 years and above, actively engaged in full-time paddy field work and exposed to chemicals, while the exclusion criteria involved those with less than a year’s experience in paddy farming and individuals unable to communicate in Bahasa Malaysia.

Data collection spanned from November 2022 to April 2023, aiming for a 5% margin of error and a 95% confidence level. Anticipating a 20% dropout rate, the estimated sample size was 120 respondents. The study employed a simple random sampling technique, selecting participants from a roster provided by KADA using a random number generator.

The written consent and a directory of farmers and farms in the Kota Bharu district were acquired by KADA. The study employed simple random sampling to choose the study location, while purposive sampling identified eligible paddy farmers who met the inclusion criteria. Subsequently, these individuals received a set of questionnaires in the Malay language. The questionnaires were distributed by the researchers at the paddy farmers’ common gathering areas after their work hours, minimizing the need for them to travel elsewhere to participate. Questionnaires and neurobehavioral assessments, including the Neurobehavioral Core Test Battery (comprising various tests like Simple Reaction Time, Minnesota Manual Dexterity, Digit Span, Digit Symbol, Benton Visual Retention, Pursuit Aiming, and Trail Making), were administered in various paddy fields at the selected location. The time taken was 40–60 minutes. Before the assessment was conducted, explanation was given to make sure that all of the respondents understood what the tests were all about.

Ethical approval was obtained from both KADA and the University’s Human Research Ethics Committees (USM/JEPeM/21010081 and USM/JEPeM/KK/23010025). Upon approval, researchers contacted unit leaders via WhatsApp apps to randomly select and approach paddy farmers. Participants received research information and consent forms before engaging in the questionnaire. The study ensured participant confidentiality, handling all identifiable information provided by participants with utmost confidentiality unless explicit consent was given for identification. No incentives or tokens were offered to participants, and there were no conflicts of interest. The collected data underwent analysis using IBM Statistical Package for Social Sciences version 27.0, following the completion of all questionnaires and assessments. Subsequently, data entry was performed for analysis. The socio-demographic information and health symptoms data of the respondents underwent univariate analysis. Descriptive statistics, including frequencies and percentages, were employed to present these findings. In evaluating the percentage of correct answers regarding knowledge, attitude, and practice on pesticide usage, Spearman’s correlation analysis was utilized. Additionally, Pearson’s Chi-square test analysis was conducted to ascertain the significance of association between selected chemical exposure factors and neurobehavioral performances among paddy farmers.

2.1 Questionnaire

The questionnaire utilized in this study, adapted from a previous study [17], comprised 53 questions divided into five sections:

1. Section A—Social Demographics: This section consists of 13 questions gathering personal information like age, gender, race, educational level, work experience period, frequency of pesticide spraying, and type of pesticide used (fungicide, rodenticide, or insecticide).

2. Section B—Health Symptoms: Encompassing queries about 14 types of health symptoms experienced by participants in the past three months due to pesticide use, such as dizziness, nausea, vomiting, and blurred vision.

3. Section C—Knowledge of Pesticide Usage: Assessing respondents’ understanding of pesticide hazards, health effects, and long-term implications. Questions were structured as yes/no options and multiple-choice queries with scoring based on correct responses.

4. Section D—Attitudes Toward Pesticide Usage: Exploring attitudes regarding personal protective equipment (PPE) use, safe handling procedures, and actions in response to visible symptoms. It includes yes/no queries and picture-based questions.

5. Section E—Practices Regarding Pesticide Usage: Evaluating practices related to safety precautions, training attendance, pesticide labeling, storage, and disposal. Questions were scored on a yes/no scale, and one question involved providing the correct answer.

The questionnaire’s reliability was assessed using Cronbach’s Alpha, yielding scores for knowledge (α = 0.669), attitude (α = 0.800), and practice (α = 0.657) [17]. Additionally, a feasibility study was conducted to assess participants’ comprehension and timing for questionnaire completion. Table 1 depicts the classification for total scores in knowledge, attitude, and practice [18].

Variables	Level	Score	Total Score (%)
Knowledge	High	18–22	81–100
	Moderate	13–17	61–80
	Low	0–12	0–60
Attitude	Concern	17–20	81–100
	Neutral	13–16	61–80
	Not concern	0–12	0–60
Practice	Good	15–18	81–100
	Fair	11–14	61–80
	Poor	0–10	0–60

Table 1.

Classification for knowledge, attitude, and practice total scores.

2.2 Neurobehavioral core test battery (NCTB)

The health effects of farmers were evaluated through a neurobehavioral core test battery (NCTB). NCTB test estimated to take around 40–60 minutes included seven tests, which were Digit Symbol, Digit Span, Pursuit Aiming, Trail Making, Benton Visual Retention, Simple Reaction Time, and Minnesota Manual Dexterity. The assessment conducted through operational guidelines from the World Health Organization was used as a reference document to ensure a standard manner of assessment (WHO, 1986). All of these tests measure different domain functions, are independent of each other, and are done in series. The neurobehavioral raw test scores were computed using a formula developed by WHO (1986) to make them comparable to the tests and scores from other studies. Table 2 depicts the neurobehavioral test components and the functional domains tested.

Test	Domain tested
Benton visual retention	Visual perception/memory
Reaction time	Attention/response speed
Pursuit aim	Motor steadiness
Digit symbol	Perceptual-motor speed
Digit Span	Short-term auditory memory
Trail making	Motor and visual coordination/steadiness
Santa Ana manual dexterity	Manual dexterity

Table 2.

Neurobehavioral tests and the domain tested.

$$Standardscore=\frac{\left(Raw\text{score}-\text{mean}\right)}{\text{Standard deviation}}x10+5$$E1

3. Results

3.1 Socio-demographic information of the respondents

Out of the intended participants, only 41 farmers opted to take part in the study (response rate of 34.2%). The frequency distribution of responses indicates that the majority of respondents were male, accounting for 82.9% of the total participants. The remaining 17.1% were female. Table 3 shows that the largest proportion of participants (41.5%) fell within the age range of 18 to 39, followed by the age range of 40 to 59 (34.1%), and 60–79 (24.4%). It was evident that the participants in this study varied in terms of age. In terms of body mass index (BMI), the majority of participants (58.5%) had a normal BMI, while 7.3% were underweight, 34.2% were overweight or obese. Regarding education level, 61.0% of the paddy farmers had completed upper secondary education, 34.1% had higher education, and 4.9% had no formal education. Among the participants, the majority (43.9%) had 1–10 years of work experience, followed by 22.0% participants with 21–30 years of experience, 19.5% participants with 11–20 years of experience, and 14.6% participants with 31–40 years of experience. Regarding pesticide handling training, 39.0% of individuals attended the program, while the remaining participants did not receive any training. In terms of pesticide usage, herbicides, fungicides, and rodenticides were the most used types (63.4%). 19.5% of participants used two types of pesticides, 9.8% of participants used only insecticides, and one participant (2.4%) used rodenticides. Regarding health problems, 56.1% of the paddy farmers reported having no health issues. The frequency of pesticide spraying varied among participants, with the “other” category being the most common response (24.4%). Some participants sprayed their crops every day and once a week (22.0%), once a month (19.5%), and once every two months (2.4%). The majority of participants (61.0%) only changed their protective equipment (PPE) when it was worn out. Others changed their PPE when it expired (24.4%) or based on other methods such as “two times in a year,” “sometimes,” and “when needed to change PPE” (7.3%). A small percentage changed their PPE once a year (4.9%), while some participants reported never changing their PPE (2.4%).

Variables	Mean ± SD	n	Percentage (%)
Gender
Male		34	82.9
Female		7	17.1
Age (years old)	45.17 ± 14.731
18–39		17	41.5
40–59		14	34.1
60–79		10	24.4
BMI	23.5211 ± 4.47450
Underweight		3	7.3
Normal		24	58.5
Overweight/obese		14	34.2
Race
Malay		41	100
Chinese		0	0
Indian		0	0
Nationality
Malaysian		41	100
Education level
No formal education		2	4.9
Primary level		0	0
Secondary level		25	61.0
Tertiary level		14	34.1
Working experience (years)	17.61 ± 11.563
1–10		18	43.9
11–20		8	19.5
21–30		9	22.0
31–40		6	14.6
Attend training program on pesticide handling
Yes		16	39.0
No		25	61.0
If YES, the agency involved
Department of Occupational Safety and Health		0	0
State department of agriculture		1	2.4
State health department		0	0
NIOSH		0	0
Department of KADA		3	7.3
Two agencies		9	22.0
Three agencies		2	4.9
Others		1	2.4
Types of pesticide used
Herbicide		2	4.9
Insecticide		4	9.8
Rodenticide		1	2.4
Two types of pesticide		8	19.5
Three types of pesticide		26	63.4
Health problems
One disease		14	34.2
Two diseases		3	7.3
Three diseases		1	2.4
No disease		23	56.1
Frequency of spraying pesticide
Everyday		9	22.0
Once a week		9	22.0
Once a month		8	19.5
Once per two months		4	9.8
Once per six months		1	2.4
Other		10	24.4
Frequency in changing of PPE
Worn out		25	61.0
Expired		10	24.4
Once a year		2	4.9
Never		1	2.4
Others		3	7.3

Table 3.

Socio-demographic distribution of the respondents (N = 41).

3.2 Health symptoms of the participants

Based on Table 4, approximately, 11 participants (26.8%) reported experiencing excessive sweating in the preceding three months. The second most prevalent health issue was skin redness, with 19.5% of participants reporting this symptom. Cough was reported by 17.1% of participants, while headache and numbness in the legs were experienced by 14.6% of participants. Stomach pain, redness of eyes, and blurred vision were each reported by 12.2% of participants. A sore throat was reported by 9.8% of participants. Chest pain, numbness in the hand, and breathing difficulty were each experienced by 7.3% of participants, while a runny nose was reported by 4.9% of participants.

Health symptoms	n	Percentage (%)
Headache	6	14.6
Cough	7	17.1
Nausea/vomiting	2	4.9
Redness of skin	8	19.5
Breathing difficulty	3	7.3
Blurred vision	5	12.2
Seizure	0	0
Runny nose	2	4.9
Chest pain	3	7.3
Sore throat	4	9.8
Redness of eyes	5	12.2
Stomach pain	5	12.2
Numbness in legs	6	14.6
Numbness in hands	3	7.3
Excessive sweating	11	26.8

Table 4.

Health symptoms on the use of pesticides (N = 41).

3.3 Distribution of levels of knowledge, attitude, and practice on pesticide usage

Table 5 depicts the distribution of scores for knowledge, attitude, and practices. In the knowledge category, 18 participants (43.9%) demonstrated high to moderate levels, while 5 participants (12.2%) exhibited a low level of knowledge. Concerning attitudes toward pesticide usage, 22 individuals (53.7%) reached a concern level, while 10 participants (24.4%) achieved a neutral level, and 9 participants (22.0%) showed no concern.

Variables	Level	n	Frequency (%)
Knowledge	High	18	43.9
	Moderate	18	43.9
	Low	5	12.2
Attitude	Concern	22	53.7
	Neutral	10	24.4
	Not concern	9	22.0
Practice	Good	28	68.3
	Fair	9	22.0
	Poor	4	9.8

Table 5.

Distribution of knowledge, attitude, and practice levels (N = 41).

Regarding practices, 28 people (68.3%) demonstrated good levels of pesticide usage, while 9 participants (22.0%) exhibited fair levels, and 4 participants (9.8%) showed poor levels of practices. Overall, fair levels (53.7%) were predominant among the participants, followed by high levels (46.3%) in the combined assessment of knowledge, attitude, and practices.

3.4 Correlation between knowledge, attitude, and practice

Table 6 presents Spearman’s correlation analysis, indicating that there was no significant correlation (p = 0.097) between the level of knowledge and attitude toward pesticide usage among paddy farmers. However, a moderate positive and statistically significant correlation (r = 0.426, p = 0.005) emerged between knowledge and practices related to pesticide usage. This suggests that a higher level of knowledge was associated with greater adherence to safe practices, indicating a significant correlation between knowledge and practices.

Variables		Knowledge	Attitude	Practice
Knowledge	r	—	0.263	0.426*
	p-value	—	0.097	0.005
Attitude	r	0.263	—	0.380*
	p-value	0.097	—	0.014
Practices	r	0.426*	0.380*	—
	p-value	0.005	0.014	—

Table 6.

Distribution scores of knowledge, attitude, and practice on pesticide usage (N = 41).

*

Significant at p < 0.05, Statistical test Spearman’s correlation.

The analyses supported a notable relationship between knowledge and practices, implying that an increase in knowledge might lead to higher adherence to safe practices regarding pesticide usage. Additionally, the correlation analysis unveiled a moderate positive and statistically significant correlation (r = 0.380, p = 0.014) between attitudes and practices concerning pesticide usage. This finding signifies that a stronger adherence to positive attitudes was linked to safer practices regarding pesticide usage. The analyses also supported a significant correlation between practices and attitudes, suggesting that an increase in positive attitudes might result in higher levels of safe practices in the context of pesticide usage among paddy farmers.

3.5 Neurobehavioral performance

Table 7 highlights that the majority of respondents exhibited abnormal performances in Minnesota Manual Dexterity (Preferred Hand) and Pursuit Aiming (48.8%), while most obtained normal scores in Minnesota Manual Dexterity (Nonpreferred Hand) (68.3%). The mean score (mean = 50) derived from the Neurobehavioral Core Test Battery (NCTB) test can serve as an indicator of each participant’s neurobehavioral performance.

Neurobehavioral Test	Neurobehavioral performance
	Normal		Abnormal
	n	%	n	%
Simple Reaction Time	27	65.9	14	34.1
Minnesota Manual Dexterity (Preferred Hand)	21	51.2	20	48.8
Minnesota Manual Dexterity (Non-preferred Hand)	28	68.3	13	31.7
Digit Span	22	53.7	19	46.3
Digit Symbol	17	41.5	24	58.5
Benton Visual Retention	26	63.4	15	36.6
Pursuit Aiming	21	51.2	20	48.8
Trail Making (Part A)	24	58.5	17	41.5
Trail Making (Part B)	23	56.1	18	43.9
Neurobehavioral Performance	21	51.2	20	48.8

Table 7.

The distribution of neurobehavioral performance among respondents.

3.6 The association between selected chemical exposure factors and neurobehavioral performances among paddy farmers

The study did not establish significant associations between several exposure factors, such as the type of chemical used, spraying time, duration, working experience, smoking habits, and changing clothes after handling chemicals with neurobehavioral performance (p > 0.05) (Table 8). Similarly, the practices of washing hands and taking a bath after handling chemicals did not yield statistically significant data due to consistent responses. However, amidst these factors, two variables exhibited notable statistical relevance.

	Neurobehavioral performance
Factors of pesticide exposure	Normal, n (%)	Abnormal, n (%)	Total, n (%)	p-value	X^2
Frequency of chemical type
Used 1–2 chemical	5 (71.4%)	2 (28.6%)	7 (100%)	0.168a	3.928
Used 3–4 Chemical	3 (27.3%)	8 (72.7%)	11 (100%)
Used >4 Chemical	13 (56.5%)	10 (43.5%)	10 (43.5%)
Spraying time
Morning	8 (42.1%)	11 (57.9%)	19 (100%)	0.422a	3.314
Evening	1 (3.33%)	2 (66.7%)	3 (100%)
Morning and Evening	10 (58.8%)	7 (41.2%)	17 (100%)
Morning, Afternoon and Evening	2 (100%)	0 (0%)	2 (100%)
Spraying frequency
Everyday	2 (22.2%)	7 (77.8%)	9 (100%)	0.005a*	0.010
Once a week	8 (88.9%)	1 (11.1%)	9 (100%)
Once a month	1 (12.5%)	7 (87.5%)	8 (100%)
Once every 2 months	3 (75%)	1 (25%)	4 (100%)
Once every 6 months	1 (100%)	0 (0%)	1 (100%)
Others	6 (60%)	4 (40%)	10 (100%)
Frequency of changing personal protective equipment
Broken	9 (36%)	16 (64%)	25 (100%)	0.050a^,*	7.490
Expired	7 (70%)	3 (30%)	10 (100%)
Once a year	1 (50%)	1 (50%)	2 (100%)
Never	1 (100%)	0 (0%)	1 (100%)
Others	3 (100%)	0 (0%)	3 (100%)
Spraying duration
<1 hours	3 (50%)	3 (50%)	6 (100%)	0.910a	0.309
1–2 hours	8 (57.1%)	6 (42.9%)	14 (100%)
≥2 hours	10 (47.6%)	11 (52.4%)	21 (100%)
BMI
Normal	15 (62.5%)	9 (37.5%)	24 (100%)	0.312	5.412
Underweight	2 (66.7%)	1 (33.3%)	3 (100%)
Overweight	2 (20%)	8 (80%)	10 (100%)
Obesity	2 (50%)	2 (50%)	4 (100%)
Smoking habit
Active Smoker	10 (62.5%)	6 (37.5%)	16 (100%)	0.721a	1.543
Passive Smoker	1 (50%)	1 (50%)	2 (100%)
Ex-smoker	3 (37.5%)	5 (62.5%)	8 (100%)
Non-smoker	7 (46.7%)	8 (53.3%)	15 (100%)
Change cloth after handling chemical
Yes	11 (44%)	14 (56%)	25 (100%)	0.341	1.336
No	10 (62.5%)	6 (37.5%)	16 (100%)

Table 8.

The association between selected chemical exposure factors and neurobehavioral performances among paddy farmers.

^a

Using Fisher’s Exact Test as Expected count <5 is more than 20% of the cells.

*

Significant at p-value <0.05.

The frequency of pesticide spraying and the frequency of changing personal protective equipment (PPE) demonstrated significant associations. Neurobehavioral performance correlated significantly with the frequency of pesticide spraying, (p = 0.005). Additionally, the frequency of changing PPE exhibited a noteworthy relationship, although slightly less significant (p = 0.05). These findings, as detailed in Table 8, underscore the importance of these particular factors concerning the studied outcomes.

4. Discussion

The demographic findings from this study reveal that the majority of paddy farmers possess a secondary education level, indicating a considerable level of knowledge among this group. Their understanding of the effects of pesticides on human health aligns with earlier studies, supporting the notion that farmers with higher knowledge levels are aware of the negative impacts of pesticides on health [19, 20]. Interestingly, most farmers in this study had not undergone specific pesticide handling instruction, a trend observed in prior research where experienced farmers rely on past experiences rather than formal training [7].

Moreover, the data from this study indicated that a significant proportion (56.1%) of paddy farmers had over a decade of experience in paddy field agriculture. This finding is consistent with previous research where respondents had substantial experience in farming, indicating a deep understanding of agricultural practices and pesticide use [21]. Experience in the rice farming sector for more than ten years has been associated with expertise in agricultural techniques and pesticide use, further emphasizing the significance of experience in shaping knowledge and practices related to pesticide management [22].

Collectively, these findings underscore the importance of both education and extensive experience in shaping farmers’ knowledge, understanding, and practices regarding pesticide usage. While formal training may not be prevalent among experienced farmers, their accumulated practical knowledge plays a pivotal role in pesticide management, highlighting the valuable contribution of hands-on experience to effective pesticide handling and agricultural practices.

Pesticide mishandling poses significant health risks to agricultural workers, as indicated by previous studies that reported that 58.8% of farmers experienced pesticide-related poisoning symptoms like headaches and vomiting [23]. Similar symptoms, such as headaches, vomiting, dizziness, and abdominal discomfort, were corroborated by other studies [24]. Extensive research on the hazards of pesticides likely contributes to the farmers’ comprehensive understanding of these health risks. However, it is crucial to note that these symptoms could also stem from various factors like weather conditions, prolonged sunlight exposure, or underlying medical conditions. In this study, excessive sweating (26.8%) was the most reported symptom, potentially influenced by the hot weather during data collection in Kelantan. Additionally, using multiple products on a single spraying day, whether in combination or separately, could result in cumulative or combined exposures to various chemicals with similar toxicological effects. This multi-product use might elevate toxicity compared to employing a single active chemical alone.

Increased knowledge and improved attitudes toward pesticide handling may enhance the workers’ capacity to self-report health symptoms associated with pesticides. Despite this awareness, some workers neglect to wear a full set of Personal Protective Equipment (PPE) while handling pesticides. Ndayambaje et al. discussed the low frequency of wearing PPE among farmers, citing reasons such as boots getting stuck in mud, and hindering compliance with recommendations [25].

While self-reported symptoms are considered unreliable predictors of pesticide poisoning [26], monitoring blood acetylcholinesterase (AChE) levels is suggested. However, interpreting AChE levels can be challenging as they primarily reflect organophosphate and carbamate exposure. Moreover, conducting blood tests in field locations with a high prevalence of blood-borne illnesses poses risks to researchers, such as exposure to HIV and HepB.

Overall, these findings emphasize the multifaceted challenges in mitigating pesticide-related health risks among agricultural workers, ranging from symptom attribution to the practical limitations of using biomarkers for exposure assessment in field settings.

The findings of this study suggest a relatively uniform level of knowledge among paddy farmers, with 43.9% demonstrating a “high” or “moderate” level. However, concerns arise regarding potential risks due to inadequate information about pesticide hazards [27] and insufficient education on appropriate pesticide usage procedures, encompassing storage, handling, and disposal [23]. Addressing these gaps is crucial through the implementation of educational initiatives and recycling programs focused on the proper management of empty pesticide containers and chemical waste.

Comprehensive knowledge plays a pivotal role in fostering safe and sustainable pesticide management and preventing subterranean water contamination [28]. Notably, the study highlights diverse sources of knowledge acquisition among farmers, primarily through interactions with retailers (52.63%), fellow farmers (25.73%), and consultancies (21.64%) [22].

Regarding attitude, incidents occurring in paddy fields have discouraged poisoned farmers from reporting injuries to healthcare facilities due to factors such as financial constraints, perceived mild severity, or inadequate access to healthcare services [29]. In terms of practices, while the general population mostly faces pesticide exposure through contaminated food and water, individuals living near pesticide-using areas or carrying contaminated items home may also experience significant exposure [30].

The ability of farmers to make informed decisions and execute proper practices relies heavily on their knowledge regarding pesticide classification, application rates, re-entry periods, and storage. A study on the Gaza Strip indicated that without adequate knowledge and practice on these aspects, farmers struggle to make informed choices and adopt proper practices [31].

Attending safe pesticide handling training emerges as a crucial factor in enhancing understanding among paddy farmers. Participation in such programs facilitates comprehension of various exposure routes (e.g., inhalation, ingestion, skin absorption) and the potential harm pesticides can cause. Furthermore, past research indicates that individuals with higher knowledge levels are more likely to adhere to prescribed recommendations for personal protective measures when using pesticides [18]. These insights underscore the pivotal role of education and training in shaping attitudes, and practices, and ultimately, ensuring safer pesticide handling among farmers.

The correlation analysis within this study did not reveal any significant relationship between the knowledge and attitudes of paddy farmers regarding pesticide usage, aligning with previous research findings. Despite considerable awareness among participants about the pesticides they use and their associated harmful effects, a notable percentage still refrained from using any pesticide applicator, potentially exposing themselves to health hazards [22]. This discrepancy in practices may stem from a lack of trust in information disseminated through media marketing compared to the guidance received from retailers and co-farmers [22].

The inefficacy of farmers’ attitudes toward the use of personal protective equipment was highlighted in the previous study, indicating an absence of significant associations between knowledge, attitudes, and the actual use of protective equipment [32]. A high level of knowledge among farmers does not necessarily translate to a similarly high degree of positive attitude. Instances such as the erroneous placement of insecticides by some farmers (13.9%) might reflect a deficiency in technical knowledge and insufficient training in pesticide safety management [20].

Interestingly, a significant correlation was observed between the knowledge and practices of paddy farmers in pesticide usage, in line with prior research indicating that good knowledge typically translates into good practices in pesticide use [33]. However, findings contrasting high knowledge levels with poor practices among farmers, as observed in rural villages in Karnataka, suggest a disconnect between awareness and practical implementation. Despite understanding the harmful effects of pesticides, a significant percentage engaged in unsafe practices such as mixing pesticides with bare hands, not wearing protective clothing during spraying, and carelessly disposing of leftover pesticides [22].

This study accentuates the need for education and awareness programs specifically tailored to the local context, considering the distinct economic, social, and individual characteristics of the Malaysian farming community. Moreover, the significant correlation between attitudes and practices in pesticide usage implies that improving attitudes can positively influence the implementation of safer practices. Notably, the disposal methods of empty pesticide containers need revision, as burning or burying such containers poses risks to both human health and the environment, requiring an expansion of participants’ knowledge of the appropriate waste management practices [33]. Additionally, the influence of peer learning and community experiences on pesticide users’ attitudes and practices emphasizes the importance of peer influence in shaping their work-related techniques [18].

The study explored various factors associated with chemical exposure among paddy farmers and their potential impacts on neurobehavioral performance. Surprisingly, despite a significant number of respondents being smokers (39%) [34], no clear relationship between smoking and neurobehavioral performance was established. Nevertheless, previous studies have highlighted the detrimental effects of nicotine on brain function, nerve health, and arterial walls, which are aspects linked to neurobehavioral issues [34].

Regarding pesticide application, the timing and frequency significantly influence exposure levels and subsequent neurobehavioral effects [35]. Farmers predominantly applied pesticides during cooler periods like early mornings and evenings to ensure rapid drying and avoid vaporization, preventing unintended spread onto non-target surfaces [35]. The frequency of pesticide application varied among respondents, with many farmers spraying daily or infrequently [36]. This frequency correlated with the type of crop, pesticide variety, and pest infestation [36]. Higher pest prevalence necessitated more frequent spraying, leading to increased chemical exposure and elevated risks to neurobehavioral performance [37].

Notably, the duration of pesticide spraying did not exhibit a direct association with neurobehavioral performance in this study, despite the majority of farmers spending more than 2 hours spraying daily [38]. The World Health Organization recommends limiting lengthy spraying to 5–6 hours a day, emphasizing regular health checks due to increased chemical exposure and absorption during prolonged spraying [38].

Regarding personal protection equipment (PPE), while farmers wore it over their work clothes, it is essential to note that chemicals can still linger on clothing [39]. However, this study did not establish a significant relationship between washing clothes after handling chemicals and neurobehavioral performance [11]. This contrasts with previous research, highlighting the importance of proper clothes washing post-chemical exposure to prevent health symptoms or diseases among farmers who handle chemicals [39].

These findings emphasize the nuanced relationships between various factors like smoking, pesticide application timing, frequency, duration, and clothes washing concerning neurobehavioral performance among paddy farmers.

5. Conclusions

The primary objective of this study was to evaluate the knowledge, attitude, and practices concerning pesticide usage among paddy farmers in Kelantan. The findings underscored that 43.9% of the participants exhibited a commendable “high” and “moderate” level of knowledge, while 53.7% expressed a “concerned” attitude, and a majority, comprising 68.3%, demonstrated “good” practices in pesticide handling. Despite the predominant absence of health issues reported by most participants (56.1%), notable symptoms like excessive sweating (26.8%), skin redness (19.5%), cough (17.1%), headache, and numbness in the legs (14.6%) were observed, likely attributed to prevailing hot weather conditions. Statistically significant, moderate, and positive correlations were discerned between knowledge and practices (r = 0.426, p = 0.05), as well as between practice and attitude (r = 0.380, p = 0.014) among the paddy farmers about pesticide use. The study also noted that nearly half of the respondents displayed normal neurobehavioral outcomes (51.2%). Among the factors associated with pesticide exposure, both the frequency of spraying and the regularity of changing personal protective equipment (PPE) emerged as significant association with neurobehavioral performance (p < 0.05). The research highlighted that a significant proportion of respondents engaged in daily chemical application, a pattern associated with a higher incidence of abnormal neurobehavioral functioning. Moreover, those who reported changing their PPE only when it was damaged or broken exhibited elevated rates of abnormal neurobehavioral outcomes compared to individuals who consistently adhered to a routine replacement of protective gear. These findings underscore the critical need for interventions and enhanced safety measures among paddy farmers to mitigate the risks associated with frequent pesticide exposure, emphasizing the importance of both prudent spraying practices and regular replacement of personal protective equipment to safeguard neurobehavioral health.

Acknowledgments

The researchers would like to thank all the respondents and the Kemubu Agricultural Development Authority (KADA), for the opportunity to conduct this research.

Conflict of interest

The authors declare no conflict of interest.