Assessment of Pesticide Knowledge, Attitudes, and Practices Among Pregnant Women in Northern Thailand Open Access

Abstract

Background and Significance: Birth cohort studies conducted in the United States have found evidence of a connection between prenatal pesticide exposure and adverse neurodevelopmental outcomes. This association is currently under investigation in developing countries such as Thailand, where an estimated 400,000 neonates born each year are at risk of prenatal exposure due to their mother's agricultural occupation. Pesticide exposure in Thailand has been linked to unsafe practices and inappropriate beliefs about pesticides. However, limited information is available on the knowledge, attitudes, and practices of pesticide use among women of child-bearing age. Obtaining this information is essential to understand the factors that influence prenatal pesticide exposure, to develop interventions that prevent exposure, and ultimately to protect pregnant women and their children from the health impacts of pesticide exposure.

Methods: Knowledge, Attitudes, and Practices surveys were administered to 76 pregnant women in northern Thailand. Multivariate logistic regression was used to assess and quantify the extent to which pesticide-related knowledge and stage of pregnancy predict pesticide use behaviors. Additional analyses were conducted to inform future interventions by determining other factors that impact behavior and identifying populations at an elevated risk of exposure.

Results: Lower knowledge and earlier stage of pregnancy were marginally significantly associated with unsafe practices in the home, but were not associated with unsafe practices at work. Women who worked in agriculture before becoming pregnant, applied pesticides in the home before becoming pregnant, or had a previous child were significantly more likely to engage in unsafe behaviors in the home during their current pregnancy. Among women who worked in agriculture, unsafe behaviors at work were associated with unsafe behaviors at home.

Discussion and Conclusions: Increasing pesticide-related knowledge among pregnant women in northern Thailand may be effective in promoting safe practices and thus reducing prenatal exposure. Although unsafe behaviors are associated with other factors such as occupation and parity, these characteristics are not preventable by nature. Thus, knowledge remains an important predictor from the perspective of prevention. Knowledge-based interventions may be most effective when implemented early in pregnancy and targeted to at-risk sub-populations.

Table of Contents

INTRODUCTION....................................................................................... 2

Pesticides: Definition and History..................................................................... 2

Classification................................................................................................ 2

Pesticide Exposure and Health Effects............................................................. 3

Pesticide Use and Regulation in the Developing World....................................... 4

Pesticide Exposure in Thailand....................................................................... 5

Pesticide Use and Regulation in Thailand......................................................... 6

Pesticide Practices in Thailand......................................................................... 7

Pesticide Attitudes in Thailand........................................................................ 9

Pesticide Knowledge in Thailand..................................................................... 10

Research Justification..................................................................................... 11

Specific Aims................................................................................................ 12

METHODS.................................................................................................. 12

Research Context........................................................................................... 12

KAP Survey Development.............................................................................. 13

Survey Administration................................................................................... 15

Data Analysis.............................................................................................. 16

Hypotheses................................................................................................. 16

Score Construction and Calculation................................................................ 17

Descriptive Statistics and Univariate Analyses................................................ 18

Multivariate Analyses and Model Construction............................................... 19

Elucidating Targets for Intervention............................................................... 22

Model Fit Statistics..................................................................................... 23

RESULTS...................................................................................................... 23

Demographic Characteristics and Pesticide Use................................................... 23

Pesticide Knowledge, Attitudes, and Practices: Descriptive Statistics....................... 24

Univariate Analyses....................................................................................... 24

Model Construction and Multivariate Analyses................................................... 25

Elucidating Targets for Intervention................................................................... 27

DISCUSSION................................................................................................ 28

Knowledge, Attitudes, and Practices.................................................................. 28

Knowledge and Stage of Pregnancy as Predictors of Practices.................................. 30

Targets for Intervention.................................................................................... 31

CONCLUSIONS AND RECOMMENDATIONS....................................... 34

Research Strengths.......................................................................................... 34

Research Limitations...................................................................................... 35

Conclusions and Recommendations.................................................................... 36

REFERENCES............................................................................................. 39

TABLES AND FIGURES............................................................................. 45

Appendix 1. Photographs of Study Site.......................................................... 85

Appendix 2. KAP Survey............................................................................... 87

Appendix 3. Institutional Review Board Approval Forms............................126

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Sciences
Keyword	Thailand pesticides prenatal exposure knowledge-based interventions
Committee Chair / Thesis Advisor	Barr, Dana Boyd, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	University, college or educational institution (other than Emory)

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