1. Introduction

2. Materials and Methods

2.3. Data Collection and Extraction

Data from the selected studies were collected after a full reading, and then organized in a detailed table according to the author(s), year of publication, objectives, characteristics of the participants, country/location where the study was conducted, type of intervention, and main results (subdivided into identified knowledge/attitudes, referred behaviours/practices, determining risk factors, and reported side effects). This detailed information is present in Table 2.

Table 2. Summary of Socioeconomic Characteristics of 15 studies included in the systematic review.

Table 2. Summary of Socioeconomic Characteristics of 15 studies included in the systematic review.

Socioeconomic Characteristics	Number of Participants	Age (years)	Sex (%)			Education (years)	Training received (1) (%)		Experience in agriculture/pesticides (years)
Akter et al (2018)	101	41,8	Male		100	1,9	Yes	19,2	11,2
			Female		0		No	80,8
Bagheri et al (2018)	200	52,9	Male		100	10,9	Yes	27,0	25,5
			Female		0		No	73,0
Mehmood et al (2019)	307	Not specified	Not specified			Not specified	Not specified		Not specified
Memon et al (2019)	260	32,6	Male	0		1,5	Not specified		9,7
			Female	100
Schreinemachers et al (2020)	1000	Not specified	Not specified			Not specified	Not specified		Not specified
Sharafi et al (2018)	311	39,6	Male	100		7,8	Yes	21,5	17,6
			Female	0			No	78,5
Bakhtawer (2021)	300	33,8	Male	93,7		6,9	Yes	19	6,8
			Female	6,3			No	81
Nwadike et al (2021)	513	40,6	Male	80,6		9,9	Yes	91,2	10,3
			Female	19,4			No	8,8
Bagheri et al. (2019)	200	52,9	Male	100		10,9	Yes	27,0	25,5
			Female	0			No	73,0
Nath et al (2022)	90	Not specified	Not specified			Not specified	Not specified		Not specified
Masruri et al (2020)	380	49,0	Male	100		7,1	Yes	27,9	16,7
			Female	0			No	72,1
Aniah et al (2021)	150	40	Male	34		1,2	Yes	59,3	6,2
			Female	66			No	40,7
Mardigian et al (2021)	104	47,7	Male	100		10,9	Not specified		Not specified
			Female	0
Sookhtanlou et al (2022)	370	46,5	Not specified			9,4	Not specified		23,6
Kumari et al (2021)	96	46	Male	84,4		Not specified	Not specified		18
			Female	15,6
Mean*		Age 43,0	Male*	73,8		Education* 7,6	Yes*	42,4	Experience* 15,8
			Female*	26,2			No*	57,6

^(1): Training received in the use of pesticides that can include training about the side effects of pesticides, banned pesticides, use of recommended dose on labels, commercial names, pesticide storage location, use of PPE, and reentry period after application, among others. *: These values only consider the studies that provide this information (exclude “not specified” studies). Not specified: this data is not included in the study.

3. Results

Figure 1. PRISMA 2020 flow diagram for updated systematic reviews, which included the search in databases and other sources.

Figure 1. PRISMA 2020 flow diagram for updated systematic reviews, which included the search in databases and other sources.

3.1. General Characteristics of the Studies

The selected studies (Table 1) followed an observational methodology; 4 are case studies (Akter et al. 2018; Bagheri et al. 2018; Memon et al. 2019; Schreinemachers et al. 2020) and 11 are cross-sectional studies (Aniah et al. 2021; Bagheri et al. 2019; Bakhtawer 2021; Kumari et al. 2021; Mardigian et al. 2021; Masruri et al. 2020; Mehmood et al. 2021; Nath and Deka 2022; Nwadike et al. 2021; Sharafi et al. 2018; Sookhtanlou et al. 2022). The duration of these studies ranged from 4 to 16 months. Their intervention involved the completion of a pre-tested and pre-defined questionnaire with several items for a face-to-face interview to the selected farmers/agricultural workers (Akter et al. 2018; Aniah et al. 2021; Bagheri et al. 2018, 2019; Bakhtawer 2021; Kumari et al. 2021; Mardigian et al. 2021; Masruri et al. 2020; Mehmood et al. 2021; Memon et al. 2019; Nath and Deka 2022; Nwadike et al. 2021; Schreinemachers et al. 2020; Sharafi et al. 2018; Sookhtanlou et al. 2022). The completion of this questionnaire was carried out either by themselves or by the responsible of each study. It should be noted that, in all studies, consent to take part in the research was collected from all participants, and their rights were thoroughly explained to them.

The results of the selected studies (Table 1) are in agreement with each other regarding the main risk factors and behaviours influencing the safe handling of pesticides in agriculture. Such studies are from non-European countries (Bangladesh, Iran, Pakistan, India, Cambodia, Laos, Vietnam, Nigeria, Ghana, and Lebanon), which indicates, on one hand, that the issue under study is still very relevant and current in underdeveloped and developing countries and, on the other hand, it reflects the lack of recent information for European countries on this issue.

Table 1. Detailed data of the included studies.

Table 1. Detailed data of the included studies.

STUDY	OBJECTIVES	PARTICIPANTS/COUNTRY	INTERVENTION	MAIN OUTCOMES
				Knowledge/Attitudes*	Practices/Behaviors**	Risk factors***	Reported side effects
Akter M et al. (2018)	Quantify the knowledge, personal background, and protective behaviors adopted by farmers; identify the factors influencing protective behaviors in pesticide use and recommend improvements in these practices.	Bangladesh N= 101 farmers	Application of a standard questionnaire (validated previously) to interview farmers (with consent) about their knowledge and practices related to pesticide use through face-to-face interviews with a demonstration of application practices, protective equipment used as well as the storage place of the products with site visits whenever possible (visual evidence). The questionnaire included 30 items on a farmer’s knowledge of pesticide use (KNO; seven items), attitude (Atti; five items), past experiences of pesticide poisoning (PE; six items), perceived outcomes (PR; four items), and protective behaviors during pesticide selection, storage, and application (PB; eight items). A Likert school (1 to 5 points) was used to code the responses in the questionnaire.	Knowledge about pesticides: Scores indicated a lack of knowledge about pesticide use (read and understand labels/pictograms/hazards of the product and choose the right product for the problem). The scores showed some knowledge of the issues related to linking pesticides to health. Most showed no knowledge that pesticides influence the acceptability and quality of products.	Preparation and spraying: Theyapply more product than the recommended quantity for fear of losing profits (they do not show a tendency to decrease). They do not believe that a reduction in pesticide application can minimize environmental pollution. The most adopted protective behavior among farmers was the correct storage of pesticides, followed by showering after application as well as not eating or smoking during application. Also, it was uncommon to post recent treatment information on the sprayed area as well as apply only the required dose of pesticide. Protective equipment used and Disposal of empty containers and waste: The least used practices were the use of adequate personal protective clothing and equipment as well as the correct disposal of waste and empty containers.	Safe behavior and practices: Relation (+): Education, level of involvement in agriculture, training in the field. Relation (-): older age, farm size, and years of pesticide application. The safe practices associated with pesticide use are more influenced by the farmer’s knowledge/attitudes and previous poisoning episodes.	Headaches, vomiting, dizziness (most frequent), eye irritation (60%), and skin irritation (50%).
Bagheri A et al. (2018)	To study the use of pesticides as well as the associated health risks and determine the protective behaviors of apple producers.	Arbadil, Iran N= 200 farmers	Application of a questionnaire (previously validated) completed face-to-face by the farmers (with consent) with questions related to socio-economic data, farming experience, household size, residence, marital status, level of education, function in agriculture, pesticide toxicity problems, safety and behaviors, use of PPE and pesticide handling practices. Farmers were asked to report only health complications caused by pesticide handling.	Knowledge about pesticides: Some producers presented training in the area; however, the training was more directed to the quantity to apply of products than to the safety matter regarding the use of pesticides.	Preparation and Spraying: Part of the producers store pesticides in warehouses, however, some still store this type of product at home (8.5%). Due to the proximity of the farm, 8.0% of the producers indicated that they prepare the grouts for spraying in their own kitchen. Most of the farmers (71.5%) stated that they prepare the sprays in the orchards or near the water points. Washing hands with hot water and soap after spraying, not eating or drinking, not smoking during spraying, changing clothes, and taking a shower after spraying were considered by almost all farmers. Keeping pesticides in safe places and using eco-friendly/low-toxic pesticides were the least considered behaviors. Disposal of empty containers and waste: Almost one in three farmers (32.8%) reported that they ’dump’ the empty containers in their orchards. Similarly, some farmers (30.2%) reported that they usually bury the empty containers and others burn the empty containers (17%) or throw them into irrigation canals, regardless of their destination (10%). Another part washes and uses them to water domestic animals (10%).	Influence on protective behaviors: Relation (+): education and training. Relation (-): agricultural experience and age.	17% of farmers have been hospitalized for pesticide poisoning. Most frequent symptoms: irritated eyes and blurred vision.
Mehmood Y et al. (2019)	To analyze the factors determining the use of personal protective equipment by producers and to assess how pesticide residues and containers are disposed of.	Pakistan N= 307 farmers	Application of a questionnaire (previously validated) to interview farmers (with consent) on information on socio-economic and farm issues, financial situation, access to finance for agriculture, costs for health protection as well as farmers’ understanding of the use of toxic chemicals and taking safety measures in this regard.	Not specified	Type of pesticides handled: Various pesticides of categories Ib, II, and III (highly hazardous, moderately hazardous, and slightly hazardous respectively) according to the WHO pesticide risk classification. Preparation and Spraying: While spraying, the protective equipment that workers use the most are: a hat/cover (33.2%), mask (28.7%), and socks/boots (12.7%). However, it is not common for them to use rubber gloves, goggles, and applicator suits. The study revealed that workers use at least one piece of personal protective equipment. Protective equipment used: Theyonly used PPE during the spraying periods. Most farmers used trousers, long-sleeved blouses/shirts, and gloves; however, they do not wear glasses or applicator suits. Disposal of empty packaging and waste:53% disposed of pesticide containers by throwing the containers onto fields or bushes as solid waste, while 18% of respondents reused empty pesticide containers for domestic or agricultural purposes. A small percentage (7%) sold empty containers to street vendors. About a fifth (21.8%) of farmers set the empty containers on fire and/or buried them. There was no collection by the recycling system in place in any of the cases.	Safe behavior and practices (use of PPE): Relation (+): Education, level of involvement in agriculture, training in the field, diversified income, access to finance. Relation (-): Age, health effects occurred, income, protective equipment costs.	Sweating, hypersalivation, dizziness, headache, skin and eye irritation, blurred vision (more frequent).
Memon Q et al. (2019)	To assess the health problems and associated costs arising from exposure to pesticides and to analyze the use of protective equipment by female workers.	Southern Pakistan N = 260 cotton pickers	Application of a pre-tested questionnaire to interview the workers with questions related to the socio-economic status of cotton pickers, source of income, awareness of pesticide hazards, health problems occurring in cotton harvesting (considered by respondents to be a result of exposure to pesticides during harvesting), personal protection practices adopted during harvesting and health facilities.	Not specified	Type of pesticides handled:Various pesticides of category II (moderately hazardous) according to the WHO pesticide risk classification. Protective equipment used:the majority did not use any type of PPE. Some workers indicated that they protect their face with some material (e.g., towel or scarf), use gloves and wear shoes during harvesting.	Use of protective measures: Relation (+): younger age, higher level of education/training. Relation (-) with illiteracy and higher experience in harvesting and health treatments.	Short-term:skin and eye injuries, headaches, stomach aches and fever (more frequent)
Schreinemachers P et al. (2020)	Quantify the excessive use of pesticides in production systems.	Cambodia, Laos, and Vietnam N= 1000 families	Application of a pre-tested questionnaire to interview workers (with consent) with questions related to crop production, pesticide use, the distinction between beneficial and harmful arthropods to crops, and questions related to spraying practices and pesticide handling.	Not specified	Preparation and Spraying:In Vietnam, 100% of producers over-applied (above the optimal amount for profit) pesticides, in Cambodia about 73% and in Laos, the percentage of over-application was 75%. This reflects unnecessary costs for producers.	Appropriate use of pesticides: Relation (+): when female gender as responsible for pest management, previous training in the area as well as contact with official entities. Relation (-): advice with pesticide sellers, belief in (over)effectiveness of pesticides, more recent experience in agriculture.	Not specified
Sharafi K et al. (2018)	To assess the knowledge/attitudes of farmers and determine the risk factors affecting the use of pesticides and consequently causing effects on their health.	Kermanshah N= 311 farmers	Application of a pre-tested questionnaire adapted from two previous ones for face-to-face completion by farmers with questions on socio-economic characteristics and farming practices, including age, gender, education level, types of crops and products, type and amount of pesticide used and income; farmers’ knowledge, attitudes and practices on pesticide use and risks and practices used for pesticide/residue disposal.	Knowledge about pesticides: Most did not have certified training in the area. Most farmers were aware that several pesticides have been banned in recent years, however, only about 18% of them knew that this was due to their high toxicity. Few had the information that pesticides had residues. Only about 15% and 29% of farmers were aware of the risks of pesticides to human health and the environment respectively. While the majority believed that pesticides do not have any adverse effect on human health, environment, or agricultural produce. Most of the respondents did not know (24.4%) or had no idea (24.8%) how to deal with the risks of pesticides. However, they indicated that reducing the dose (42.4%), using personal protection (30.5%), and using low-risk products (14.8%) can reduce the risk associated with pesticides.	Type of pesticides handled:various pesticides of categories Ib, II and III (highly hazardous, moderately hazardous, and slightly hazardous respectively) according to the WHO pesticide risk classification. 61% of farmers used pesticides based on their own experience without reading the instructions. Preparation and Spraying:Most farmers (62.7%) wash their hands and face after application. Protective equipment used:Only about 18% of farmers use personal protective equipment for the body (face and hands). Disposal of empty packaging and waste:Most of the farmers (52.7%) claimed that they stored the surplus pesticides for another use. About 16% of the farmers employed the surplus pesticide/wash residues on the treated land or on uncultivated land, which, means unnecessary use of pesticides. About 10% of the farmers were dumping the wastes into rivers and other waterways. Most of them (41.2%) dispose of the packaging with waste. None of them dispose of the empty containers properly, using a specific program for their collection and recycling.	Prevalence of health implications: Relation (+): training in the area or higher level of education. Relation (-): age over 65 years, untrained farmers applying highly toxic pesticides.	Skin irritation and dizziness (most frequent symptoms).
Bakhtawer S (2021)	To assess farmers’ knowledge/attitudes and practices in the use of insecticides against pests.	Punjab, Pakistan N=300 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). The first part is related to the socio-demographic characteristics of respondents, such as gender, marital status, age, level of education, agricultural area, irrigation method, agricultural experience, and working hours they spend on the crops. The second part is related to farmers’ perceptions about which insecticides are more effective and which they use more, which crop and pest are most frequently mentioned, methods of preparing the dose to apply considering the pests encountered, knowledge about alternative pest control methods, biological agents or natural enemies. The third part referred to the respondents’ attitudes and practices regarding their protection during spraying, use of personal protective equipment, and participation in training in the area.	Knowledge of pesticides:only 7% have some qualification acquired in the area and 12% have training on the use of insecticides. Most of them get the name of the products and use them for pests only following the indications of the agricultural technician. Little knowledge was revealed about integrated pest management and the biological pest control method. Preparation and Spraying:42% of respondents understand the label instructions when preparing for spraying. Alternative to insecticides: 63% did not know of its existence while 37% were aware of it. 68.6% had no knowledge about integrated pest management. 65.3% of the respondents did not know any information about the biological pest control method.	Type of pesticides handled:various pesticides of category II (moderately hazardous) according to the WHO pesticide risk classification. Preparation and Spraying:42% of respondents understand the label instructions while preparing for spraying. 22% of respondents were able to prepare an adequate dose, while 15% of respondents followed the pesticide application plan. Protective equipment used:the most used measures are the use of rubber gloves (44%), mask (41%), and/or covering the face with some material (e.g.: cloth). Disposal of empty containers and waste:50.33% of the respondents bury the empty containers and 14% of the respondents burn them, while 31.67% throw them in the rubbish without any processing. Only 3.67% of the respondents proceed to collection centers for the disposal of empty insecticide containers.	Safe practices in the use of insecticides: Relation (+): level of education and consequently knowledge about pest control procedures, interpretation of product labels, frequency and quantity of product to be applied, use of personal protective equipment, and appropriate disposal of empty containers and waste.	Not specified
Nwadike C et al. (2021)	Assess farmers’ knowledge/attitudes and safe practices in pesticide use.	Northern Nigeria N= 524 farmers	Application of a pre-tested questionnaire to face-to-face interviews with workers (with consent). Data collected include socio-demographic characteristics, knowledge about frequently used/purchased pesticides, pesticide exposure routes, pesticide control methods, storage and disposal, use of PPE, attitudes towards the hazardous effect of pesticides, farmers’ practices during pesticide application, and health problems associated with pesticide use. The factors considered include farmers’ knowledge of safety during pesticide application, on-farm handling, and possible health/environmental and safety effects of the most adopted practices during and after pesticide use on farms. Farmers’ attitudes about pesticide use and associated impact were measured using a 5-point Likert scale.	Knowledge about pesticides:58.8% were able to identify inhalation as the most likely route of entry of pesticide residues into the human body. The oral route (ingestion) was identified as the second most possible route of exposure (54.5%). 60.3% said they were aware of secondary routes of pesticide exposure, including ingestion of contaminated food and drinking water contaminated with pesticides, etc. Limited knowledge of the risk classification of each pesticide according to WHO classification. High knowledge of the safe application of pesticides as well as a high knowledge of the safe use of personal protective equipment. Knowledge on how to dispose of pesticide residues and expired products and on the safe storage of pesticides received slightly lower scores. High knowledge was found on practices to avoid during pesticide preparation and application (e.g., eating and/or drinking and smoking).	Preparation and Spraying:87.9% said they read the product safety data sheet/packaging label before applying the product on their plots. An unsafe practice for worker safety and health observed was: 32% of respondents stated that during pesticide application when one of the nozzles of the sprayer is clogged, they use their mouth to proceed to unblock it. Protective equipment used:the most used measures are the use of rubber gloves, masks, and applicator suits. Disposal of empty packaging and waste:30.6% of participants use empty pesticide containers for other agricultural or domestic uses, thus exposing farmers to potential health problems associated with this practice.	Safe practices in the use of pesticides: Relation (+): gender, experience, and agricultural practice do not influence the use of empty containers for other household purposes. A higher educational level positively influences reading product labels before use as well as other safety practices. Relation (-): older age and low educational level influence the use of empty containers for other domestic purposes as well as the use of protective equipment and the use of the mouth to unclog sprayer nozzles.	Headaches, dizziness, skin and eye irritation, coughing, nausea, and vomiting.
Bagheri A et al. (2019)	To assess the knowledge/attitudes and perceptions of apple producers regarding the use of pesticides.	Ardabil, Iran N= 200 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). Data collected include basic demographic characteristics of farmers, main pests in apple plantations, trust, and use of information sources on pesticides, knowledge, attitudes, and perceptions related to pesticide use, and adoption of safety practices by farmers in the use of these products using a 5-point Likert scale.	Knowledge of pesticides:Low knowledge regarding pest control management. The score reveals a moderate level of knowledge of pesticides among the respondents namely on environmental problems arising from over-application as well as for the effects on existing "healthy" crops. Most of the respondents perceived that spraying is harmful to the health of the applicators who do not protect themselves during spraying and that spraying should be carried out only by skilled personnel. The scores indicated a positive perception of the overall implications of pesticide use (e.g., they did not agree that decreasing spraying means decreasing profits).	Type of pesticides handled:fungicides, herbicides, insecticides, and acaricides. Preparation and spraying:Most rely on pesticide dealers as a trusted source of information for correct product application. Most farmers stated that they wash their hands with soap and water after spraying while a large proportion stated eating and drinking during spraying. Also, many of the farmers stated that they do not smoke during spraying. 75% indicated that they do not read pesticide labels.	Correct knowledge, attitudes, and perceptions about pesticide use: Relation (+): credible and official information sources as well as younger age and naturally acquired professional experience. The level of personal and family literacy also positively influences knowledge, attitudes, and perceptions. Relation (-): previous experience of poisoning.	Not specified
Nath A et al. (2022)	To assess the knowledge/attitudes and practices of people regarding pesticide use and the occurrence of acute toxicity symptoms.	India N= 90 farmers	Application of a pre-tested questionnaire to interview farmers face-to-face.	Knowledge about pesticides:82.2% used chemical pesticides and most recognized them as harmful.	Type of pesticides handled:52% belong to WHO class II (moderately hazardous), 8% belong to class III (slightly hazardous) and 4% belong to class Ib (highly hazardous). Protective equipment used:75.7% reported not using any individual protection measures. 13.51% stated that they did not use differentiated work clothes or wash them separately despite applying pesticides.	Knowledge, attitudes, and correct practices on the use of pesticides: Relation (-): lack of adequate knowledge, risky behavior during handling; inappropriate storage and disposal of pesticides.	Episodes of acute poisoning from pesticide use:headache, nausea, irritated eyes, vomiting, decreased breathing, disturbed vision, and excessive sweating.
Masruri B et al. (2020)	To determine the knowledge and practices of farmers towards the use of pesticide insurance.	Iran N= 380 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). The questions included topics on farmers’ knowledge of pesticide safety as well as their practices in this regard. The topics were rated using a 5-point Likert scale.	Knowledge about pesticides: 92.1% of them reported that they had not participated in any training on pesticide safety. 41.6% of the farmers had a low level of knowledge and 58.4% had a moderate level of knowledge about pesticide side effects, storage, transport, and disposal conditions as well as precautions when handling toxic products. Most of the farmers studied had good knowledge about the prohibition of eating and drinking at the application site, as well as the use of personal protective equipment such as masks. On the other hand, only about 40% of the workers knew about the prohibition to reuse empty containers for other purposes and about the prohibition to burn them.	Precautionary measures in the storage, transport, and disposal of pesticides:62.6% of the participants had a moderate practice and 37.4% of them had a good practice in this regard. Protective equipment used:only 58.2% of the farmers always washed their clothes after spraying, 29.5% always wore gloves and 1.6% boots, 7% always wore safety glasses, and 17.6% protective masks. 1.6% of the farmers always used appropriate clothing. Another part of the farmers indicated that it is not a common practice to use the protection equipment listed.	Knowledge and safe practices in the use of pesticides: Relation (+): age, experience, and level of education/training.	Not specified
Aniah P et al. (2021)	To assess farmers’ actual knowledge and practices regarding the use of pesticides and evaluate the ways in which they are obtained.	Ghana N= 150 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). Questions include individual characteristics such as age, gender, educational level, farm size, duration of pesticide application, and knowledge and understanding of the safe use of pesticides.	Knowledge about pesticides: About 95% of the farmers did not have adequate knowledge of the environmental and health implications of pesticide use. 59.3% were trained on the use of personal protective equipment. 53% of the farmers are, however, unable to adequately understand the correct meaning of pictograms. Farmers show low knowledge regarding the toxic effects of pesticides.	Type of pesticides handled:the pesticides identified belong to WHO class II (moderately hazardous) and class Ib (highly hazardous). Preparation and Spraying:most farmers (91.5%) reported that they do not read the label of pesticides before use. 77%, revealed that some of the pesticides they buy do not even have labels or instructions. Farmers usually use much more than the recommended dose of the various pesticides they handle. Protective equipment used: 3.3% of farmers wore gloves and masks and less than 2% wore boots. While most of the farmers (90.2%) wore jackets and long sleeve shirts. Storage:63% of farmers stored their pesticides inside their own homes, while the rest (37%) stored their pesticides in a warehouse or a no-food zone. Disposal of empty packaging and waste:Most farmers (over 90%) indicated that they disposed of empty packaging by burying it in the soil or burning it.	Health effects: Relation (+): between pesticide use and eye irritation as well as between pesticide use and headache, vomiting, and nausea.	Generalized discomfort, vomiting, headaches, nausea, and eye irritation. 96.7% of respondents reported having suffered pesticide poisoning at least once.
Mardigian P et al. (2021)	Assessing farmers’ practices and determining risk factors that incorrectly affect pesticide use	Lebanon N= 146 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). The questions include socio-demographic characteristics, of the farm and questions related to usual practices in pesticide application.	Knowledge about pesticides: Most farmers indicated that they did not know the active substances of the pesticides they use. However, they relied on their own education, research, and experience to obtain information on the safe use of pesticides. 59.6% agreed that exposure to pesticides could result in short-term and long-term health effects. When asked about possible long-term health effects of pesticide exposure, almost half of the respondents (49%) mentioned at least one associated disease (cancer, depression and neurological deficits, respiratory diseases, gastrointestinal disorders, reproductive disorders, skin problems, eye problems, and kidney failure). Only 58.7% of respondents believed that pesticides could have negative effects on the environment, the rest were unaware of the issue.	Type of pesticides handled:the choice of pesticides as well as the indications for the safe use of pesticides is made by the suppliers (family/friends). Preparation and Spraying: 87.5% of respondents said that they respect the recommended dose on the package label during the application, both themselves and their workers. 74.6% of farmers indicated that they have increased the use of pesticides because of environmental issues or because of issues related to the loss of effectiveness of a certain amount of product, pest resistance to the product, and/or beliefs that higher doses have more effectiveness). 85.4% said they monitored wind direction before spraying. Most reported not eating/drinking (95.8%), nor smoking (87.5%) during spraying activities. In addition, 93.7% said they shower and change clothes immediately after spraying. Protective equipment used: 41.4% reported mixing the different pesticides using their hands without protection or a stick and only 36.5% reported wearing gloves during mixing. Willingness to use fewer toxic products:when asked about the possibility of using a less toxic product with equal efficacy, 87% of respondents were willing to switch, motivated mainly by the price difference. The remaining indicated that they did not want to switch as they were satisfied with the product and would only do so on the advice of the current supplier.	Safe practices in the use of pesticides: Relation (-): Costs of products influence the choice of products. A belief that pesticides are currently ineffective and therefore do not cause problems due to dermal contact (devaluation of toxicity). Willingness to use a safe pesticide: Relation (+): younger age and education.	Death of one of the workers due to poisoning caused by exposure to pesticides.
Sookhtanlou M et al. (2022)	Analyze the health risks for farmers arising from the use of pesticides.	Ardabil, Iran N=370 farmers	Application of a pre-tested questionnaire to interview workers face-to-face (with consent). The questions include sociodemographic and occupational characteristics of potato growers, questions related to the rate of pesticide use per area, and questions regarding protective measures and behaviors adopted throughout all stages of pesticide use. The topics were evaluated using a 5-point Likert scale.	Not specified	Type of pesticides handled:pesticides used were mostly in WHO class II (moderately hazardous). Most of the respondents (39.4%) belonged to the group of potato growers who were exposed to high health risks, while 30.8% and 29.8% of the groups were exposed to moderate and low health risks respectively. Preparation and Spraying:74.6% of farmers used pesticides in excess and only 24.6% used within the allowed levels or below the recommended levels. The main protection measures adopted by farmers include determining the type of pesticide appropriate for the pest/disease, "checking their production and expiry dates", "preparing pesticides outside the house", "wearing boots" and "changing the suit after pesticide application". Dangerous behaviors:buying pesticides from unreliable outlets, not carefully reading instructions on pesticide labels, not paying attention to selecting an appropriate sprayer that is compatible with the pesticide/crop, and unsafe disposal of pesticide packaging and waste (burying, burning, etc.).	Safe pesticide uses behaviors and practices: Relation (-): age. Education, farm income, knowledge/perception of seriousness, and awareness of adopting safe behaviors as well as perceived benefits and beliefs influence (in both directions) the adoption of safe behaviors during pesticide use and contribute to the increase in the list of health risks for producers.	Not specified
Kumari D et al. (2021)	To assess farmers’ knowledge and safety practices regarding pesticide use and the health effects associated with this exposure.	North India N= 96 workers	Application of a questionnaire based on the WHO standard protocol (1982) for pesticide exposure surveys to face-to-face interviews with workers (with consent). Questions include socio-demographic characteristics; types, amount, frequency of pesticide application, knowledge/information, practices in pesticide use; familiarity with WHO label risk classification, and self-reports on experiences of health effects from pesticide application.	Knowledge about pesticides: Most farmers (97%) showed knowledge of the harmful effects of pesticides. Almost all farmers agreed that direct ingestion of pesticides was toxic however only 31% expressed an understanding of the risk of poisoning by consuming food (e.g., vegetables and fruits) with pesticide residues. 57% of respondents believed that empty pesticide containers could be reused after washing. Only 24% of applicators had certified training in pesticide spraying. Interpretation of the risk classification defined by the WHO: The data indicate that 59% of respondents identified the WHO classifications on pesticide containers, but only very few respondents knew what the information meant. Of the four categories (excluding the most recent U), only 18% of respondents knew the meaning of the red category and 6% knew the meaning of the green color category. However, no one could explain the meaning of the yellow and blue color categories on pesticide containers. About 76% of the participants were not aware of these classifications. Only the red color classification was interpreted as dangerous.	Type of pesticides handled:the most used pesticides were fungicides and insecticides in class II (moderately hazardous) and Ib (highly hazardous). Preparation and Spraying:most pesticide applicators (92%) always wash their hands and 96% always change their clothes after use. Eating during and at the spraying site was practiced by 17% of respondents while 51% always drank water on site. Most respondents (> 65%) stored pesticides and related products in their own homes. Pictures taken confirmed this fact and indicated that products are handled with bare hands without gloves (15%). Only 32% followed the proper mixing procedure. Protective equipment used: 53% of respondents always wore long-sleeved shirts, 37% always wore hats and 48% always wore masks while handling pesticides. Disposal of empty packaging and waste:Most respondents burn (65%) and about 12% were seen burying the empty packaging. No one used the practice of handing over the packaging to an entity responsible for waste management and recycling recommended by FAO/WHO.	Lack of knowledge about the effects of pesticides and lack of understanding of the WHO-defined pesticide toxicity classification is associated with an increased likelihood of unsafe practices in pesticide use.	Eye and skin irritation.

4. Discussion

5. Limitations

6. Conclusions

References

1. Afshari, M., Karimi-Shahanjarini, A., Khoshravesh, S., & Besharati, F. (2021). Effectiveness of interventions to promote pesticide safety and reduce pesticide exposure in agricultural health studies: A systematic review. PLoS ONE, 16(1 January). https://doi.org/10.1371/JOURNAL.PONE.0245766. [CrossRef]
2. Akoto, O., Andoh, H., Darko, G., Eshun, K., & Osei-Fosu, P. (2013). Health risk assessment of pesticides residue in maize and cowpea from Ejura, Ghana. Chemosphere, 92(1), 67-73.
3. Akter, M., Fan, L., Rahman, M. M., Geissen, V., & Ritsema, C. J. (2018). Vegetable farmers’ behaviour and knowledge related to pesticide use and related health problems: A case study from Bangladesh. Journal of Cleaner Production, 200, 122–133. https://doi.org/10.1016/J.JCLEPRO.2018.07.130. [CrossRef]
4. Amirahmadi, M., Shoeibi, S., Abdollahi, M., Rastegar, H., Khosrokhavar, R., & Hamedani, M. P. (2013). Monitoring of some pesticides residue in consumed tea in Tehran market. Iranian journal of environmental health science & engineering, 10, 1-6.
5. Aniah, P., Kaunza-Nu-Dem, M. K., Dong-Uuro, P. P., Ayembilla, J. A., & Osumanu, I. K. (2021). Vegetable farmers’ knowledge on pesticides use in Northwest Ghana. Environment, Development and Sustainability, 23(5), 7273–7288. https://doi.org/10.1007/s10668-020-00916-6. [CrossRef]
6. ANIPLA. (2016). Manual Técnico Segurança na Utilização de Produtos Fitofarmacêuticos.
7. Bagheri, A., Emami, N., Allahyari, M. S., & Damalas, C. A. (2018). Pesticide handling practices, health risks, and determinants of safety behavior among Iranian apple farmers. Human and Ecological Risk Assessment, 24(8), 2209–2223. https://doi.org/10.1080/10807039.2018.1443265. [CrossRef]
8. Bagheri, A., Emami, N., Damalas, C. A., & Allahyari, M. S. (2019). Farmers’ knowledge, attitudes, and perceptions of pesticide use in apple farms of northern Iran: impact on safety behavior. Environmental Science and Pollution Research, 26(9), 9343–9351. https://doi.org/10.1007/s11356-019-04330-y. [CrossRef]
9. Bakhtawer, S. A. (2021). A cross sectional survey of knowledge, attitude and practices related to the use of insecticides among farmers in industrial triangle of Punjab, Pakistan. PLoS ONE, 16(8 August). https://doi.org/10.1371/journal.pone.0255454. [CrossRef]
10. Barizon, R. R. M., Figueiredo, R. de O., de Souza Dutra, D. R. C., Regitano, J. B., & Ferracini, V. L. (2020). Pesticides in the surface waters of the Camanducaia River watershed, Brazil. Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes, 55(3), 283–292. https://doi.org/10.1080/03601234.2019.1693835. [CrossRef]
11. Bhandari, G., Zomer, P., Atreya, K., Mol, H. G. J., Yang, X., & Geissen, V. (2019). Pesticide residues in Nepalese vegetables and potential health risks. Environmental Research, 172, 511–521. https://doi.org/10.1016/j.envres.2019.03.002. [CrossRef]
12. Bondori, A., Bagheri, A., Damalas, C. A., & Allahyari, M. S. (2018). Use of personal protective equipment towards pesticide exposure: Farmers’ attitudes and determinants of behavior. Sci Total Environ 639: 1156–1163.
13. Dalmolin, S. P., Dreon, D. B., Thiesen, F. V., & Dallegrave, E. (2020). Biomarkers of occupational exposure to pesticides: Systematic review of insecticides. Environmental Toxicology and Pharmacology, 75. https://doi.org/10.1016/j.etap.2019.103304. [CrossRef]
14. de Graaf, L., Boulanger, M., Bureau, M., Bouvier, G., Meryet-Figuiere, M., Tual, S., Lebailly, P., & Baldi, I. (2022). Occupational pesticide exposure, cancer and chronic neurological disorders: A systematic review of epidemiological studies in greenspace workers. Environmental Research, 203. https://doi.org/10.1016/j.envres.2021.111822. [CrossRef]
15. de Moura, L. T. R., Bedor, C. N. G., Lopez, R. V. M., Santana, V. S., da Rocha, T. M. B. da S., Filho, V. W., & Curado, M. P. (2020). Occupational exposure to organophosphate pesticides and hematologic neoplasms: A systematic review. Revista Brasileira de Epidemiologia, 23. https://doi.org/10.1590/1980-549720200022. [CrossRef]
16. de-Assis, M. P., Barcella, R. C., Padilha, J. C., Pohl, H. H., & Krug, S. B. F. (2021). Health problems in agricultural workers occupationally exposed to pesticides. Revista Brasileira de Medicina Do Trabalho : Publicacao Oficial Da Associacao Nacional de Medicina Do Trabalho-ANAMT, 18(3), 352–363. https://doi.org/10.47626/1679-4435-2020-532. [CrossRef]
17. DGAV. (2021). Resíduos de Pesticidas. https://www.dgav.pt/alimentos/conteudo/generos-alimenticios/garantir-a-seguranca-dos-alimentos/residuos-de-pesticidas/.
18. Ernst, F., Alonso, B., Colazzo, M., Pareja, L., Cesio, V., Pereira, A., ... & Pérez-Parada, A. (2018). Occurrence of pesticide residues in fish from south American rainfed agroecosystems. Science of the total environment, 631, 169-179.
19. Garcês, A., Pires, I., & Rodrigues, P. (2020). Teratological effects of pesticides in vertebrates: a review. Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes, 55(1), 75–89. https://doi.org/10.1080/03601234.2019.1660562. [CrossRef]
20. Gillezeau, C., Van Gerwen, M., Shaffer, R. M., Rana, I., Zhang, L., Sheppard, L., & Taioli, E. (2019). The evidence of human exposure to glyphosate: A review. Environmental Health: A Global Access Science Source, 18(1). https://doi.org/10.1186/s12940-018-0435-5. [CrossRef]
21. Giulioni, C., Maurizi, V., Scarcella, S., Di Biase, M., Iacovelli, V., Galosi, A. B., & Castellani, D. (2021). Do environmental and occupational exposure to pyrethroids and organophosphates affect human semen parameters? Results of a systematic review and meta-analysis. Andrologia, 53(11). https://doi.org/10.1111/and.14215. [CrossRef]
22. Hou, X., Han, M., Dai, X., Yang, X., & Yi, S. (2013). A multi-residue method for the determination of 124 pesticides in rice by modified QuEChERS extraction and gas chromatography–tandem mass spectrometry. Food Chemistry, 138(2-3), 1198-1205.
23. Kafilzadeh, F. (2015). Assessment of organochlorine pesticide residues in water, sediments and fish from Lake Tashk, Iran. Achievements in the Life Sciences, 9(2), 107-111.
24. Knauer, K. (2016). Pesticides in surface waters: a comparison with regulatory acceptable concentrations (RACs) determined in the authorization process and consideration for regulation. Environmental Sciences Europe, 28(1), 13. https://doi.org/10.1186/S12302-016-0083-8. [CrossRef]
25. Kumari, D., Sebastian, A. J., & John, S. (2021). Pesticide handling practices and health risks among the apple orchard workers in Western Indian Himalayan region. Human and Ecological Risk Assessment, 27(1), 15–29. https://doi.org/10.1080/10807039.2019.1689353. [CrossRef]
26. Lopes, J., Coutinho, L., & Fernando Pessoa, U. (2010). Avaliação ecotoxicológica da exposição a uma formulação comercial contendo dois pesticidas: atrazina e s-metalocloro.
27. López-Gálvez, N., Wagoner, R., Quirós-Alcalá, L., Van Horne, Y. O., Furlong, M., Avila, E., & Beamer, P. (2019). Systematic literature review of the take-home route of pesticide exposure via biomonitoring and environmental monitoring. International Journal of Environmental Research and Public Health, 16(12). https://doi.org/10.3390/IJERPH16122177. [CrossRef]
28. Lucero, B., & Muñoz-Quezada, M. T. (2021). Neurobehavioral, Neuromotor, and Neurocognitive Effects in Agricultural Workers and Their Children Exposed to Pyrethroid Pesticides: A Review. Frontiers in Human Neuroscience, 15, 648171. https://doi.org/10.3389/fnhum.2021.648171. [CrossRef]
29. Mardigian, P., Chalak, A., Fares, S., Parpia, A., El Asmar, K., & Habib, R. R. (2021). Pesticide practices in coastal agricultural farms of Lebanon. International Journal of Environmental Health Research, 31(2), 132–147. https://doi.org/10.1080/09603123.2019.1634797. [CrossRef]
30. Masruri, B., Dehdari, T., Yekzamani, P., Moghadasi, N., & Ashtarinezhad, A. (2020). Assessment of knowledge and practice of pistachio farmers in terms of pistachio pesticide safety. Https://Doi.Org/10.1080/10807039.2020.1744111, 27(3), 595–605. https://doi.org/10.1080/10807039.2020.1744111. [CrossRef]
31. Matich, E. K., Laryea, J. A., Seely, K. A., Stahr, S., Su, L. J., & Hsu, P. C. (2021). Association between pesticide exposure and colorectal cancer risk and incidence: A systematic review. Ecotoxicology and Environmental Safety, 219. https://doi.org/10.1016/j.ecoenv.2021.112327. [CrossRef]
32. Mehmood, Y., Arshad, M., Mahmood, N., Kächele, H., & Kong, R. (2021). Occupational hazards, health costs, and pesticide handling practices among vegetable growers in Pakistan. Environmental Research, 200. https://doi.org/10.1016/J.ENVRES.2021.111340. [CrossRef]
33. Memon, Q. U. A., Wagan, S. A., Chunyu, D., Shuangxi, X., Jingdong, L., & Damalas, C. A. (2019). Health problems from pesticide exposure and personal protective measures among women cotton workers in southern Pakistan. Science of the Total Environment, 685, 659–666. https://doi.org/10.1016/J.SCITOTENV.2019.05.173. [CrossRef]
34. Morgado Gomes, F. R. (2018). Conhecimentos dos agricultores na utilização dos pesticidas na Zona Centro de Portugal: impacte na sua saúde. Instituto Politécnico de Viseu.
35. Myzabella, N., Fritschi, L., Merdith, N., El-Zaemey, S., Chih, H., & Reid, A. (2019). Occupational health and safety in the palm oil industry: A systematic review. International Journal of Occupational and Environmental Medicine, 10(4), 159–173. https://doi.org/10.15171/IJOEM.2019.1576. [CrossRef]
36. Nascimento, L., & Melnyk, A. (2016). A química dos pesticidas no meio ambiente e na saúde The chemistry of pesticides in the environment and health. Artigo Revista Mangaio Acadêmico, 1.
37. Nath, A., & Deka, P. (2022). A Case Study on Practices and Acute Toxicity Symptoms Associated with Pesticide Use Among the Farmers of Mid Brahmaputra Valley of Assam. 329–344. https://doi.org/10.1007/978-3-030-95542-7_16. [CrossRef]
38. Negatu, B., Dugassa, S., & Mekonnen, Y. (2021). Environmental and Health Risks of Pesticide Use in Ethiopia. Journal of Health and Pollution, 11(30), 1–12. https://doi.org/10.5696/2156-9614-11.30.210601. [CrossRef]
39. Nwadike, C., Joshua, V. I., Doka, P. J. S., Ajaj, R., Hashidu, U. A., Gwary-Moda, S., Danjin, M., & Moda, H. M. (2021). Occupational safety knowledge, attitude, and practice among farmers in northern nigeria during pesticide application—a case study. Sustainability (Switzerland), 13(18). https://doi.org/10.3390/su131810107. [CrossRef]
40. Paixão, S., Ferreira, A., Lança, A., & Teixeira, P. (2016). Gestão de riscos em aplicadores de produtos fitofarmacêuticos. Revista Portuguesa de Saúde Ocupacional, 2, 102–109. https://doi.org/10.31252/RPSO.21.09.2016. [CrossRef]
41. Panis, C., Kawassaki, A. C. B., Crestani, A. P. J., Pascotto, C. R., Bortoloti, D. S., Vicentini, G. E., Lucio, L. C., Ferreira, M. O., Prates, R. T. C., Vieira, V. K., Gaboardi, S. C., & Candiotto, L. Z. P. (2021). Evidencia sobre la exposición humana a plaguicidas y la ocurrencia de riesgos para la salud en la población brasileña: una revisión sistemática. Frontiers in Public Health, 9. /pmc/articles/PMC8777228/.
42. Passos, J. D. C., Felisbino, K., Laureano, H. A., & Guiloski, I. C. (2022). Occupational exposure to pesticides and its association with telomere length - A systematic review and meta-analysis. Science of the Total Environment, 849. https://doi.org/10.1016/j.scitotenv.2022.157715. [CrossRef]
43. Perry, J., Cotton, J., Rahman, M. A., & Brumby, S. A. (2020). Organophoephate exposure and the chxonic effects on farmers: A narrative review. Rural and Remote Health, 20(1). https://doi.org/10.22605/RRH4508. [CrossRef]
44. Prudente, I. R. G., Cruz, C. L., Nascimento, L. de C., Kaiser, C. C., & Guimarães, A. G. (2018). Evidence of risks of renal function reduction due to occupational exposure to agrochemicals: A systematic review. Environmental Toxicology and Pharmacology, 63, 21–28. https://doi.org/10.1016/J.ETAP.2018.08.006. [CrossRef]
45. Rani, L., Thapa, K., Kanojia, N., Sharma, N., Singh, S., Grewal, A. S., Srivastav, A. L., & Kaushal, J. (2021). An extensive review on the consequences of chemical pesticides on human health and environment. Journal of Cleaner Production, 283. https://doi.org/10.1016/J.JCLEPRO.2020.124657. [CrossRef]
46. Rocha Matias, D. M. (2015). Prevalência de Intoxicações por Pesticidas na População da Beira Interior: Experiência Profissionalizante na vertente de Farmácia Comunitária e Investigação. Universidade Da Beira Interior - Ciências Da Saúde.
47. Santos, M., & Almeida, A. (2016). Agricultura e saúde laboral. Revista Portuguesa de Saúde Ocupacional, 2, S79–S84. https://doi.org/10.31252/RPSO/01.08.2016. [CrossRef]
48. Schreinemachers, P., Grovermann, C., Praneetvatakul, S., Heng, P., Nguyen, T. T. L., Buntong, B., Le, N. T., & Pinn, T. (2020). How much is too much? Quantifying pesticide overuse in vegetable production in Southeast Asia. Journal of Cleaner Production, 244. https://doi.org/10.1016/J.JCLEPRO.2019.118738. [CrossRef]
49. Seenivasan, S., & Muraleedharan, N. (2011). Survey on the pesticide residues in tea in south India. Environmental monitoring and assessment, 176, 365-371. [CrossRef]
50. Serapicos Vilarinho, R. A. (2019). Conhecimentos e Comportamentos dos Agricultores do Concelho de Macedo de Cavaleiros sobre os Pesticidas Rui Alexandre Serapicos Vilarinho.
51. Sharafi, K., Pirsaheb, M., Maleki, S., Arfaeinia, H., Karimyan, K., Moradi, M., & Safari, Y. (2018). Knowledge, attitude and practices of farmers about pesticide use, risks, and wastes; a cross-sectional study (Kermanshah, Iran). Science of the Total Environment, 645, 509–517. https://doi.org/10.1016/J.SCITOTENV.2018.07.132. [CrossRef]
52. Sookhtanlou, M., Allahyari, M. S., & Surujlal, J. (2022). Health Risk of Potato Farmers Exposed to Overuse of Chemical Pesticides in Iran. Safety and Health at Work, 13(1), 23–31. https://doi.org/10.1016/J.SHAW.2021.09.004. [CrossRef]
53. Teixeira, F. (2014). Utilização de Pesticidas Agrícolas (ACT -Autoridade para as Condições do Trabalho, Ed.).
54. Varghese, J. V, Sebastian, E. M., Iqbal, T., & Tom, A. A. (2021). Pesticide applicators and cancer: a systematic review. Reviews on Environmental Health, 36(4), 467–476. https://doi.org/10.1515/reveh-2020-0121. [CrossRef]
55. Wahlang, B. (2018). Exposure to persistent organic pollutants: Impact on women’s health. Reviews on Environmental Health, 33(4), 331–348. https://doi.org/10.1515/REVEH-2018-0018. [CrossRef]
56. Wang, J., Chen, G., Christie, P., Zhang, M., Luo, Y., & Teng, Y. (2015). Occurrence and risk assessment of phthalate esters (PAEs) in vegetables and soils of suburban plastic film greenhouses. Science of the Total Environment, 523, 129-137. [CrossRef]
57. Yahia, D., & Elsharkawy, E. E. (2014). Multi pesticide and PCB residues in Nile tilapia and catfish in Assiut city, Egypt. Science of the Total Environment, 466, 306-314. [CrossRef]
58. Yuantari, M. G., Van Gestel, C. A., Van Straalen, N. M., Widianarko, B., Sunoko, H. R., & Shobib, M. N. (2015). Knowledge, attitude, and practice of Indonesian farmers regarding the use of personal protective equipment against pesticide exposure. Environmental monitoring and assessment, 187, 1-7. [CrossRef]
59. Zúñiga-Venegas, L., Saracini, C., Pancetti, F., Muñoz-Quezada, M. T., Lucero, B., Foerster, C., & Cortés, S. (2021). Pesticide exposure in Chile and population health: urgency for decision making. Gaceta Sanitaria, 35(5), 480–487. https://doi.org/10.1016/j.gaceta.2020.04.020. [CrossRef]