Sustainable Futures 2 (2020) 100026

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Sustainable Futures
journal homepage: www.elsevier.com/locate/sftr

Effects of pesticides on farmers’ health in Tu Ky district, Hai Duong

province, Vietnam
Vu Ngoc Huyen a, Nguyen Van Song a,∗, Nguyen Thi Thuy a,b, Le Thi Phuong Dung c,
Luong Khanh Hoan a
a
Faculty of Economics and Rural Development (FERD), Vietnam National University of Agriculture (VNUA), Trauquy, Gialam, Hanoi, Vietnam
b
Vietnam National University of Agriculture Press (VNUAP), Vietnam National University of Agriculture (VNUA), Trauquy, Gialam, Hanoi, Vietnam
c
Fisheries and Technical Economic College, Tuson, Baninh, Vietnam

a r t i c l e i n f o a b s t r a c t

Keywords: The survey on 300 farming households in Tu Ky district, Hai Duong province, Vietnam show that their knowledge
Pesticides about plant protection drugs is still very limited. Farmers do not understand the meaning of the colors and the
Effects contours on the packaging. The treatment of excess drugs and hygiene activities after pesticide application show
Health
that farmers’ awareness is not high, thereby leading to environmental pollution and reduction in the physical
Cost of ill
health of farmers. The results about the effects of pesticides and herbicides on the health of farmers in Tu Ky dis-
Health cost
trict show that farmers often suffer from diseases such as eyes, ears, nose, and throat diseases, skin diseases, and
gastrointestinal disorders. The proportion of farmers suffering from common diseases in communes specializing
in vegetable production is higher than that of communes specializing in rice production. In particular, the pro-
portions of deaths from cancer in Hung Dao and Ngoc Ky communes were 48.5% and 43.6%, respectively, much
higher than that of An Thanh Commune (7.9%). In addition to the number of farmers and the high incidence of
cancer deaths in the vegetable production area is compared to those in rice production area. COI of households at
Hung Dao is 7,493 thousand VND (318 USD) and 5,996 thousand VND (255 USD) as compared to 1,742 thousand
VND (74 USD) of An Thanh; The relative number is an increase of 340% - 430% compared to the pure rice pro-
duction commune. This study aims to analyze and evaluate the types of pesticides, dosage, preparation method,
timing, spraying time and behaviors after spraying of rice producers (An Thanh) and vegetable producers in Ngoc
Ky and Hung Dao; The study results point out and confirm the special role of management, usage instructions,
enhancement of production knowledge, types of drugs used, and non-used drugs and spraying tools, especially
for vegetable production areas. For vegetable production areas, it is necessary to plan separate production areas
for each type of vegetables, not intercropping vegetables, to provide detailed guidance on the specific type of
drugs, the dosage, the time, timing, frequency, and pesticide application method for each type of vegetables. It is
also of importance for farmers not to use pesticides leftover of this type of vegetable to other types of vegetables
or spray the field borders. Vegetables are usually processed and consumed immediately, which means the time
of delivery to consumers is very short, so it is important to help farmers fully understand the degree of negative
impact on not only themselves, producers, but also on consumers, on society in the short run and in the long run.
Producers and consumers even pay for their lives when using plant protection drugs, using agricultural products,
especially vegetables. Health insurance is an important method of sharing disease risks of farmers in general and
vegetable producers in particular.

1. Introduction mans. Many localities found groundwater containing pesticide residues

The use of plant protection drugs (pesticides) has been the leading
measure that farmers use to prevent harmful insects, diseases and pro-
tect crops. In addition to the effectiveness for agriculture, plant pro-
tection drugs also have negative effects on the environment and hu-
that exceeded safe water standards [17]. This is particularly harmful to
farmers and rural communities, where pesticide poisoning and related
cancers are not uncommon [4].
On average, Vietnam spends nearly 2.5 million USD per day on im-
porting pesticides and materials. Imports of pesticides and raw materials
are mainly from China, accounting for 50.2% of the total import value,

∗
Corresponding author.
E-mail address: nguyensonghua@gmail.com (N. Van Song).

https://doi.org/10.1016/j.sftr.2020.100026
Received 28 October 2019; Received in revised form 3 March 2020; Accepted 2 April 2020
2666-1888/© 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license.
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
V.N. Huyen, N. Van Song and N.T. Thuy et al.
equivalent to about 297.7 million USD. In the first 7 months of 2018,
the import value of this commodity increased in major markets, such as
the UK market (increased by 29%), Malaysia (increased by 20.2%), India
(increased by 15.5%) Singapore (increased by 10.8%) and Germany (in-
creased by 4.4%). On average, in the past 5 years, Vietnam spent about
500 million USD each year to import pesticides and raw materials from
China; of which, 48% was herbicides (19,000 tons), while insecticide
and disease drugs accounted for about 32% (16,400 tons) in addition to
a small amount of growth-regulating drugs, about 900 tons. [12].
The volume of active ingredients of plant protection drugs per
hectare of crop per year in Vietnam is up to 2 kg, while some other
countries in the region range from only 0.2–1 kg/ha. According to the
Department of Science, Technology and Environment, Ministry of Agri-
culture and Rural Development, the average amount of inorganic fertil-
izers is about 2.4 million tons/year, each year, it releases about 240 tons
of packaging and boxes while the amount of pesticides remaining on
the packaging accounts for 1.85% of the packaging density. Meanwhile,
farmers are completely unaware of handling the remaining pesticides
on the packaging. More than 65% of the farmers surveyed claimed they
threw away packaging right at the drug dispensing site. This fact is caus-
ing the environment in rural areas to deteriorate rapidly. Not only that,
the widespread use of pesticides and fertilizers also poses huge risks to
human health. According to international experts, up to 80% of plant
protection drugs in Vietnam are being used improperly, unnecessarily
and very wastefully, 30% of farmers use pesticides in contravention of
regulations such as failing to ensure water quantity, without labor pro-
tection, using pesticides at wrong concentrations [21]. In rice alone,
there have been 3321 pesticides; For vegetables, there are also 260 pes-
ticides, etc. Experts warn that the use of plant protection drugs is at an
alarming level, even in some places, there is a phenomenon of farmers
"addicted" to use plant protection drugs [3].
Tu Ky district, located in the Eastern part of Hai Duong province,
Vietnam, is a district with natural conditions suitable for a variety of
growing plants. Hai Duong is located in the Red River Delta, together
with the Mekong Delta, which produces over 90% of the total rice pro-
duction of Vietnam. In addition to rice as a staple product, many com-
munes in the district are conducting the production of vegetables such
as potatoes, corn, courgette, melon, garlic and onion, etc. for domestic
consumption and export. The seasonal changes in temperature leads to
erratic high and low humidity, creating conditions for harmful insects
and diseases that are harmful to crop production in general and in veg-
etable production in particular; and harmful insects and diseases in veg-
etable production appear to be more servere than in other agricultural
production. To protect rice and crops from pests and diseases, farmers in
Tu Ky district often apply plant protection drugs. However, their aware-
ness of the impact of plant protection drugs on human health and the
environment is still limited. The study on the effect of plant protection
drugs on the health of farmers in Tu Ky district, therefore, aimed to com-
pare the differences of the impact of plant protection drugs on the health
of farmers in communes specializing in vegetable production and com-
munes specializing in rice production and tp assess the impact of plant
protection drugs on medical examination and treatment costs of farm-
ers. Through the study, solutions and recommendations are proposed to
minimize the harmful effects of plant protection drugs.
2. Literature review
Research on the effects of education has shown good results in rais-
ing awareness on pesticide risks [8]. Atreya [2] calculates that the cost
of pesticides is equal to one-third of the total cost of health care services.
The results of the study by Khan et al. [9] in Tehsil Bahawalpur in Pak-
istan reveal that health indicators depend on farmers ’literacy, pesticide
quantities, farmers’ age, use of safety measures, farmer awareness, pesti-
cide toxicity, exposure to pesticide trading years, age (experience), and
interaction between pesticides and the most harmful training in pesti-
Sustainable Futures 2 (2020) 100026
cide use and handling’. Information from pesticide sellers increases the
application of preventive tools and then improves health outcomes [1].
The risks for the natural environment after using pesticides in agricul-
ture are found to be closely related to human health [30]. There was a
significant increase in pesticide use (+56%) and although there was an
improvement in pesticide handling practices, trained farmers may have
faced health risks. The ecological research results of Schreinemachers
et al. [24] and Klemick & Lichtenberg [14] shows that pesticide use is
harmful to fish populations. Moehring used common quantitative indi-
cators to point out that using less pesticides effectively reduces envi-
ronmental and health risks [20]. Integrated pest management (IPM) is
the ideal means to reduce pesticide use and protect the environment
from pollution, helping to ensure food safety and thus protecting hu-
man health [6]. Pest management is achieved directly by using a va-
riety of tools, including pesticides and indirectly through some agro-
nomic/cultural practices such as irrigation and fertilization; This collec-
tive practice has a positive effect on plant health in general [22].
Macharia et al. [18] show that the incidence of pesticide-related ill-
nesses has increased. Changes in the number of symptoms and severity
of symptoms significantly explain the Cost of Illness (COI). The record
and geographic location significantly define health decline. Dragomir
[5] concludes that the number of pesticides has decreased but human
health effects are worrisome. Sexton et al. [25] propose management
policies and pesticide use in the larger context of agricultural and en-
vironmental management. A study by Waibel & Garming [28] shows
that farmers are willing to spend about 28% of the current cost of pesti-
cides to avoid health risks. Exposure to pesticides has had a significant
impact on farmers’ nervous, liver and kidney systems. The IPM pro-
gram not only benefits farmers and the environment but also stimulates
and benefits the entire Indonesian economy [23]. Khan [10] highlighted
the results of random pricing to measure the medical costs of pesticide
use. Results showed that farmers were willing to pay to avoid pesticide-
related health risks. Travisi et al. [27] used meta-analysis to investigate
changes in WTP estimates for pesticide risk reduction. Their findings
show that willingness to pay (WTP) reduces risk by a specific level of
risk. A study by Féménia and Letort [7] shows that a small tax on the use
of pesticides can provide agricultural producers with economic incen-
tives to apply low input to their crop production. Khan et al. [9] point
out that the highest proportion of farmers (38%) are willing to pay more,
20% higher than insurance premiums to use pesticides more safely, to
avoid health risks of pesticides. Learning outcomes of Khan [11] have
concluded that more than 77% of farmers have experienced at least one
health symptom. Maumbe and Switon [19] used COI to evaluate the
impact of pesticide use, concluding that pesticide-induced acute symp-
toms increased disease costs in a survey of 280 small cotton growers in
two districts of Zimbabwe. Cotton growers lose an average of $ 180 Z in
Sanyati and Z $ 316 per year in Chipinge due to the direct and indirect
effects related to pesticides. These values are equivalent to 45% and
83% of annual household pesticide spending. Results of a study about
pesticide use and health outcomes in China by Lai [16] showed that pes-
ticide use increased by 10% at a disadvantage. This equates to 2.13 and
0.64 million USD for medical and family expenses. Wilson and Tisdell
[29] concludes that the use of input chemicals such as pesticides has
increased agricultural production and productivity; however, negative
externalities also increased. Mortality and morbidity among agricultural
workers, especially in developing countries from exposure to pesticides,
are also common. The study by Lai [15] about pesticide use in China
indicates that a 10% increase in the use of rice pesticides changed the
dependency index by 2.51% and 0.33% for local and downstream res-
idents (aged 65 years and above), respectively. This is the equivalent
of 168.8 and 55.89 million USD in medical costs and manpower losses,
respectively (totalling 1.92% of rice production profits). The findings of
Kim and Lee [13] are that the total annual costs for deaths and illnesses
due to pesticide use in the United States are estimated at 38.83 million
USD.
V.N. Huyen, N. Van Song and N.T. Thuy et al.
Fig. 1. Locations of the three study sites in Tu Ky district, Hai Duong province.
3. Methodology
3.1. The selection of sample and location of study
Located in the Red River Delta, along with Thai Binh, Hai Phong,
Hung Yen, Ha Noi, Bac Ninh, Nam Dinh, and Ha Nam provinces, etc., Hai
Duong province plays an important role in supplying food for the whole
country and exporting agricultural products, especially rice and vegeta-
bles. Tu Ky district is one of the 12 administrative units of Hai Duong
province. The district is located in the Southeast of Hai Duong province,
with 01 town (Tu Ky) and 26 communes. Tu Ky is a district specializ-
ing in rice and vegetable production. The district has a total natural
land area of 16,813 ha, of which agricultural land is 11,226.94 ha, in-
cluding agricultural production land (9876.52 ha); land for aquaculture
(1336.3 ha); and other agricultural lands (14.12 ha). Its total population
is 158,769 people; the average population density is 923 people/km2 .
The total number of people of working age is 99,904 (88,905 people in
economic sector; and 2968 in government offices) [26].
The three communes of Tu Ky district (Fig. 1) were selected for the
study, namely Ngoc Ky, Hung Dao and An Thanh. They have similar eco-
nomic, social and environmental conditions, but only differ in farming
methods and agricultural products. Therefore, comparative method was
employed for the purpose of this study. Ngoc Ky commune has a popu-
lation of 4530 people, Hung Dao commune has a population of 12,660
people, An Thanh commune has a population of 8250 people.
Tu Ky district has a total of 11,212.06 ha of agricultural land, ac-
counting for 66.88% of the natural area of the whole district; of which
the cultivated land is 8497.79 ha, accounting for 75.79% of the agricul-
tural land, the land for perennial crops is only 1363.62 ha (12.16%), and
aquaculture land is 1336.53 ha (11.92%). These figures show that Tu
Ky is a purely agricultural district, the farmers’ income is mainly from
annual crop production. Farmers in the district mostly use pesticides to
control pests and diseases in their annual crops.
The study was carried out on 300 households in the selected 3 com-
munes (100 households/commune); in which, Hung Dao and Ngoc Ky
communes are two communes with a tradition of producing vegetables.
An Thanh commune is a commune specializing in rice production with
very few farmers producing vegetables. Farmers in An Thanh commune
are less exposed to plant protection drugs than farmers in Hung Dao and
Ngoc Ky communes. Therefore, the study in the three communes may
help to compare the health situation under the impact of plant protec-
Sustainable Futures 2 (2020) 100026
Table 1
Area and structure of agricultural land use in 2018.
Type of land use Area (ha) Percentage (%)
Total area of agricultural land 11,212.06 100
1- Annual crop land (cropland) 8497.79 75.79
+ Land for rice production 8349.43 74.47
+ Other annual crop lands 148.36 1.32
2- Land for planting perennial trees 1363.62 12.16
3- Land for aquaculture 1336.53 11.92
4- Other agricultural lands 14.12 0.13
Source: Compilation from survey data (2018).
tion drugs between the commune specializing in vegetable production
and the commune specializing in rice production. For the purpose of the
study, 100 households in each commune were randomly selected from 3
hamlets in the commune, which means 33 or 34 households were each
selected per hamlet.
3.2. Data processing, analysis, and estimation
Descriptive statistics is used throughout the study to describe the
current status of the usage of plant protection drugs in the selected
communes and the health status of the farmers. In addition, in order
to clarify the impact of plant protection drugs on farmers’ health, the
comparative method is used to compare and contrast the level of the
usage of plant protection drugs to the health of farmers in the commune
specializing in vegetable production with the commune specializing in
rice production. The study also used the Cost of Illness (COI) method to
measure the impact of plant protection drugs on the health care costs of
farmers. The formulae for estimating health costs are as follows:
Treatment cost = Average cost of treatment × Number of farmers
with infected diseases × Number of days in the hospital
Opportunity cost = Duration of the infected diseases (duration of the
treatment) × Average income/day
The data collected from the survey are mostly qualitative, encoded
into numbers and processed by Excel software.
Total treatment costs for all households in the commune or dis-
trict = Number of households × Average cost of treatment of each
household.
4. Results and discusions
4.1. General information about the interviewed households
The study conducted interviews with 300 farming households ran-
domly selected from the three study commnues. The average age of the
householders is 47.3 years old, the average number of family members
is 3.52 people/household. The householder is often the one who makes
business and investment decisions in the family. 57% of the surveyed
householders are men, which indicates that men still play an important
role in the family. The householders with secondary education account
for the majority (32.6%) and the percentage is similar in all three com-
munes. There are very few householders with college or university de-
grees, which is a limitation in acquiring technical advances from mass
media and short-term training courses at commune and district levels
for the householders.
As can be seen from Table 2, the average age of the surveyed house-
holders is 47.3 years old. The average age of Hung Dao commune is
49.13 years old, of Ngoc Ky commune is 47.56 years old and of An
Thanh commune is 45.2 years old. The average age of the household-
ers between communes shows that there is no significant difference be-
tween the average ages between the communes. Information on the
gender/sex of the householders shows that most of the householders
are male. In the 300 samples, 172 male-householders account for 57%,
128 female-householders account for 43%. In Hung Dao commune,
V.N. Huyen, N. Van Song and N.T. Thuy et al. Sustainable Futures 2 (2020) 100026

Table 2
General information of the surveyed households.

Criteria Unit Total/Average Hung Dao Ngoc Ky An Thanh

1. Number of households households 300 100 100 100

2. Sex people 300 100 100 100
Male people 172 57 61 54
Female people 128 43 39 46
3. Average age years old 47.3 49.13 47.56 45.2
4. Educational level
Primary school % 28.8 26.8 29.6 30.1
Secondary school % 32.6 33.1 31.6 33
High school % 22.5 22.5 23.3 21.6
Complementary education % 5.8 6.8 5.2 5.5
Intermediate vocational training % 4.1 4.3 4.2 3.7
College % 3.3 3.7 3.1 3.2
University % 2.9 2.8 3.0 2.9
5. Household size - laborers
Average number of family members/ household persons/household 3.52 3.59 3.46 3.55
Average number of laborers / household persons/household 2.38 2.34 2.54 2.28

Source: Compilation from survey data (2018).

Table 3 Table 4
The structure of total product value according to the actual price of Tu Popular plant protection products applied in production in Tu Ky district.
Ky district.
Explanation Proportion (%)
Criteria 2016 (%) 2017 (%) 2018 (%)
1. Belong to types of Pesticides 63.57
Total value 100 100 100 Disease drugs 36.43
1. Agriculture, forestry, fisheries 41.80 37.34 34.19 2. Belong to types of Chemistry 79.37
2. Industry, construction 34.27 37.20 39.27 Biology 20.63
3. Services, trade 23.93 25.46 26.54 3. Belong to groups of I 0.00
II 12.48
(Source: [26]). III 68.77
IV 18.75
4. Included in the list (catalog) for Yes 100.0
male-householders account for 57% and female-householders account rice, vegetables allowed to use No 0.00
for 43%. In An Thanh commune, male-householders account for 54%, Source: Production surveyed data (2018).
female-householders account for 46%; and in Ngoc Ky commune male-
householders account for 61%, female-householders account for 39%.
Thus, in the selected communes, men play an important role in making The proportion of agriculture - forestry - fisheries, industry-
business and investment decisions in the family and are the executives in construction; and services and trade in 2018 was 34.19%, 39.27%,
investing in production and application of new science and technology 26.54%, respectively, as compared to the figures in 2016 which was
advances and in expanding production scale. Having such an important 41.80%, 34.27%, and 23.93%, respectively. In recent years, the growth
and decisive role in the family, men are the ones who make the decisions rates of industry - construction and service sectors have increased
on the types and amounts of pesticides to be used in their agricultural rapidly and much higher than the average rate of the whole district,
production. This gives a policy implication which is when propagating while the growth rate of agriculture, forestry and fishery sector dereased
information to limit the negative effects of pesticide use, it would be gradually. Therefore, the economic structure has been shifted towards
more effective to focus on male farmers. reducing the proportion of agriculture, forestry and fishery and increas-
The educational level of the householders is one of the important fac- ing the proportion of industry – construction sector; however, the pro-
tors reflecting the level of awareness and uptake of the application of portion of the value of gross output from agriculture - forestry - fisheries
science and technology in production and market access. In the 300 sur- (34.19% in 2018) still plays an important role in the income and eco-
veyed households, there are no illiterate households. All surveyed house- nomic structure of the locality.
holds have educational attainment at Primary school or higher, the ma-
jority of educational attainment of the householders is Secondary school. 4.2. The situation of using plant protection drugs by producers in Tu Ky
Households with secondary education account for 33.1% in Hung Dao, district
31.6% in Ngoc Ky and 33% in An Thanh. Households with high school
education in all three communes account for over 21%, which is an 4.2.1. The number and categories of drugs
advantage for household’s production, because households with higher Results of surveys and studies show that farmers apply many differ-
education will have better knowledge and production since they can eas- ent plant protection drugs to kill pests for rice, vegetables, and fruits.
ily absorb new technical advances from various sources such as news- According to survey data of producers in three communes of Tu Ky dis-
papers, books, and mass media. trict and Hai Duong, farmers use the following 31 common pesticides
According to the survey data, the average number of members in (Table 4).
the household is 3.52 persons/household. Hung Dao commune has a According to the data in Table 4, it can be seen that farmers mostly
higher number of members with 3.59 persons/household, followed by use plant protection products which are included in the list of drugs
An Thanh commune with 3.55 people/household and finally Ngoc Ky allowed to use, and most of them are pesticides (63.57%) and pesti-
commune with 3.46 persons/household. The average number of labor- cides/drugs of chemical origin (79.37%). According to the WHO rec-
ers per household in all three communes is 2.38 persons/household, ommended classification of pesticides by hazard categorizes, although
equivalent to 66.3% of the number of household members. This infor- producers in the 3 study communes do not use extremely toxic plant pro-
mation shows the potential of the labor force in each household, and of tection drugs (group I), but the proportion of farmers using pesticides
the whole society. in group II is still relatively high (12.48%). Such types of pesticides be-
V.N. Huyen, N. Van Song and N.T. Thuy et al.
long to Group II which are more commonly used, consist of Selecron
500EC, Peran 10EC, and Regent 800WP. These are the types of pesti-
cides that should be recommended for farmers to limit their use. The
majority of types of pesticides which are more commonly used belong
to the Group III (68.77%), while the remaining 18.75% of farmers use
less toxic pesticides for the environment and health (Group IV pesti-
cides such as Delfin WG, Success 25SC, Bitadin WP, Exin 4.5 HP, and
Biobac 50WP). Therefore, it is necessary to change farmers’ awareness
to increase the proportion of farmers using Group IV pesticides in pro-
duction at the locality, in order to be able to attain safer, more friendly
production to human health and the environment in the future.
4.2.2. Time and timing of pesticide application
Choosing the right time to spray is the third principle that must
be strictly followed and plays an important role in protecting farm-
ers’health and the environment. To spray plant protection drugs at the
right time is the impact at a time when the pest density is at a high level,
the instance for pests to be easily affected, the plants with the best toler-
ance and favorable external conditions to help the drug promote expire.
If the timing of spraying is not appropriate, not only will the insects not
die, there will also be adverse effects on crop yields, the environment
and human health.
From the results of the above survey, it is found that farmers often
spray pesticides in the early morning and late afternoon, accounting
for a high proportion. For 2 communes Hung Dao and Ngoc Ky, 90.5%
of households sprayed in the early morning and late afternoon, while
the largest number of households spraying is in An Thanh commune
with 95%. This suggests that farmers in An Thanh commune have the
highest awareness about the proper time of spraying to attain the best
application effect. An Thanh commune is a rice-growing commune with
rich experience in rice cultivation, and the types of pesticide they used
are not as diverse, as Ngoc Ky and Hung Dao communes where farm-
ers mostly grow vegetables and fruits. According to the study, at these
two times, most pests and diseases appear on the land surface during
the day. For spraying in the morning, depending on the types, drugs
can be sprayed early when there is still frog in order to increase the
dispersion of the drug evenly in the foliage and in the morning, the
vegetable plants absorb better internal absorption drugs into the trunk,
However, most of the time when spraying in the morning, the house-
holds should be sprayed to dry the mist, with the bacterial disease fields
if sprayed early, in the fog there are bacteria, when spraying, the sprayer
will bring the source of bacteria to spread throughout the field. For treat-
ment drugs in the contact form, the afternoon and afternoon are often
windy so the amount of drug flying in the air is quite high. Consider-
ing the mushroom’s growth cycle, the mushrooms need 12–14 h to have
enough moisture (in the evening) to grow. If the farmers spray pesticides
during the day, the cell wall of the fungus shrinks, so the drug invades
to make the effect more difficult.
In An Thanh, farmers sprayed drugs more in time because they only
grow rice, so the time of spraying was informed by the commune agri-
cultural extension officers and were often sprayed synchronously, while
pesticide spraying equipment for rice also more synchronized, more uni-
form. For the two control communes, Ngoc Ky and Hung Dao, besides
rice production are the two main crops, the farmers here also grow a lot
of different kinds of vegetables, therefore, the time of spraying for each
crop is very different, there are many different types of drugs, and the
spraying tools are also more complex and less modern, which leads to
more frequency application of drugs and more direct contact of farmers
with pesticides.
4.2.3. Method of drug infusion
The amount of drug sprayed reflected by the amount and dosage of
the drugs used in the drug mixing formula of households. Proper mix-
ing of drugs helps to effectively spray, to avoid pests resistant to drugs,
not to waste the drug, further reducing damages to human health, crops
and the surrounding environment. The survey results show that farmers
Sustainable Futures 2 (2020) 100026
in Ngoc Ky and Hung Dao communes specializing in vegetable produc-
tion, 48.5% of farmers mix drugs based on their own experience, 91%
of farmers mix drugs when spraying plant protection products, only 6%
spray and mix the medicine according to the extension staff’s instruc-
tions, and only 16.5% read the directions/instructions on the package. In
An Thanh, only rice production, the amount of medicine, the medicine
as well as the way to mix pesticides is uniform and all households mix
drugs according to agricultural extension instructions.
The data from Table 6 show that the function of agricultural exten-
sion officers in the two communes specializing in vegetable production,
Hung Dao and Ngoc Ky, has been relatively limited. The more com-
plicated quantity, types of drugs and pesticide ingredients applied for
vegetable cultivation in these communes make farmers less interested
in agricultural extension guidelines. They depend more on sellers’ in-
tructions while many businesses sometimes put profits first where the
shop owners’ main concern is to sell the highest possible amount of plant
protection products, so sometimes the shop owners will advise farmers
to buy higher drug infusion than standard dosage. As a result, the ratio
of farmers overdosing in the study sites is very high.
Users do not fully understand the importance of dissolving plant
protection drugs into water for spraying. If it is insoluble, it cannot be
sprayed evenly and the drugs spray does not achieve the desired effect,
causing waste of drugs, seriously affecting the health of the community
and the surrounding environment. In 94.5% of farmers who use a stir-
ring tool, the majority of them use sticks or rods that have been prepared
at home or out in the field looking for the remainders, 5.5% think that
just by shaking the bottle with their hands and that will dissolve the
medicine. From this result, it is implied that agricultural extension in
communes specializing in vegetable production needs to be more active
and specific in detail when instructing farmers to mix pesticides.
4.2.4. The use of labor protection equipment
Most farmers are aware of the role of using labor protection equip-
ment when applying plant protection drugs. 100% of the respondents
said that they always use labor protection equipment, but the frequency
of regular use of vegetable production commune is only 81%, while
that of An Thanh commune is only 75%. An Thanh commune special-
izes in rice production. For rice production, in the commune, they are
using a large scale pesticide spraying machine, so farmers are less ex-
posed directly and repeatedly to plant protection drugs than farmers at 2
communes specializing in vegetable production. Therefore, when asked
about the frequency of using labor protection equipment, only 75% of
farmers in An Thanh commune answered yes.
However, the full use of protection is not emphasized by direct
sprayer. If farmers are aware of the harmful effects of plant protection
drugs, the more they use protective equipment, the more they help farm-
ers to isolate and avoid direct contact with plant protection drugs.
This result shows that the functional departments of district and com-
mune leaders must strengthen and encourage farmers, especially farm-
ers in Ngoc Ky and Hung Dao communes, to use more modern spraying
tools, more simultaneously. To plan the planting of vegetables into sep-
arate areas, specialized in each separate area without producing frag-
mented, alternating, if intercropping of vegetables makes one type of
vegetable affected by many drugs due to each vegetable has a pest and
disease that leads to the phenomenon of a vegetable being affected by
many kinds of medicine, many times of spraying of neighboring vegeta-
bles.
100% of the surveyed households use face masks and hats/caps dur-
ing the process of spraying plant protection products. However, the use
of the other types of labor protection equipment such as gloves, boots,
glasses and raincoats is not adequate. In Hung Dao and Ngoc Ky com-
munes, the majority of farmers use gloves (57.0%), boots (81.50%), but
they rarely use glasses (16.0%) and raincoats (11.0%). The correspond-
ing rates for An Thanh commune are 71.0% using gloves, 74.0% using
boots, only 17% using glasses and 15% using raincoats. The reason why
households rarely use raincoats is because it makes them feel hot and
V.N. Huyen, N. Van Song and N.T. Thuy et al. Sustainable Futures 2 (2020) 100026

Table 5
Time and timing of pesticide application of the production households in Tu Ky district in 2018.

Total figure of Hung Dao and Ngoc Ky

Hung Dao commune Ngoc Ky commune communes An Thanh commune

Number of Percentage Number of Percentage Number of Percentage Number of Percentage

Timing of application
households (%) households (%) households (%) households (%)

Early morning and late 93 93 88 88 181 90.5 95 95

afternoon
Midday, noonday 0 0 0 0 0 0 0 0
Anytime 7 7 12 12 19 9.5 5 5

Source: Compilation from survey data (2018).

Table 6
Practice of spraying and mixing pesticides in Hung Dao and Ngoc Ky communes.

Hung Dao commune Ngoc Ky commune Total

Number of Percentage Number of Percentage Number of Percentage

Explanation
households (%) households (%) households (%)

1. According to the instructions of drug sellers 13 13 14 14 27 13.5

2. According to the instructions on the package 15 15 18 18 33 16.5
3. According to the instructions of the extension officers 7 7 5 5 12 6
4. According to the neighbors 13 13 18 18 31 15.5
5. Personal experience 52 52 45 45 97 48.5
6. Percentage of farmers mixing drugs (%) 89 89 93 93 182 91
7. Use stirring/ mixing tools 95 95 91 91 186 93
8. Use a kneading tool
+ Use hands to shake 7 7 4 4 11 5.5
+ Use a mixing tool (stick/rod) 93 93 96 96 189 94.5

Source: Compilation from survey data (2018).

Table 7
The use of labor protection equipment during pesticide application of the surveyed households.

Total of Hung Dao and Ngoc

Hung Dao commune Ngoc Ky commune Ky communes An Thanh commune
Criteria
Number of Number of Number of Number of
households Percentage (%) households Percentage (%) households Percentage (%) households Percentage (%)

1. Level of usage of labor - Usually 79 79 83 83 162 81 75 75

protection equipment - Sometimes 21 11 17 17 38 14 25 25
2. Types of labor - Face mask 100 100 100 100 200 100 100 100
protection equipment - Gloves 65 65 49 49 114 57 71 71
- Boots 78 78 85 85 163 81.5 74 74
- Caps/hats 100 100 100 100 200 100 100 100
- Glasses 17 17 15 15 32 16 17 17
- Raincoat 13 13 9 9 22 11 15 15

Source: Compilation from survey data (2018).

sweat a lot, especially in the summer, which are uncomfortable for them
when spraying the drugs. Therefore, it can be seen that the awareness of
households of using protection during pesticide application is not high;
and the awareness of farmers in An Thanh commune about the use of
labor protection in the spraying process is higher than the awareness
of the other 2 communes, Ngoc Ky and Hung Dao. However, due to
the characteristics of short-term vegetable production the cultivation of
many kinds of vegetables, and the existence of many kinds of harmful
worms and pests, spraying should be repeated. That is the reason why
the farmers in the communes specializing in vegetable production also
need many more types of labor protection equipment than the others.
4.2.5. Farmers’ behaviors after pesticide application
The majority of respondents said that they dispose of empty pesticide
containers/packaging right at the landfill in the field, 26.5% for Ngoc Ky
and Hung Dao communes and 31% for An Thanh commune. More than
20% of farmers in Hung Dao and Ngoc Ky communes throw away the
drug containers anywhere convenient, while in An Thanh commune,
the proportion is up to 30%. The percentage of farmers throwing the
pesticide containers in the right places in the communes specializing in
vegetable production and the commune specializing in rice production
is similar. When asked about the reason, the households shared that the
commune’s tank for dumping pesticide containers was far away from
their fields, so it was hard and time-consuming for them to go there
and throw the pesticide containers. This behavior is very harmful to the
environment, we need to change farmers’awareness and help them to
behave more properly.
Regarding the leftover drugs mixture, to avoid wasting, the surveyed
households used up all of the leftover pesticides, the percentage of farm-
ers using all of the unused pesticides in the communes specializing in
vegetable production (94.5%) was much higher than that of the com-
munes specializing in rice production. They often spray around the field
to eliminate all the pests and diseases, 5% of the surveyed households
choose to spray excess pesticide mix on other crops to save the left-
over. 3% of farmers in Ngoc Ky and Hung Dao communes and 8% of the
farmers in An Thanh poured the leftover drugs directly into ditches and
ponds. This behavior also has very negative impacts on the environment
and direct adverse effects on the health of the farmers because the canal
water will contaminate the water and the soil, hiding many dangers for
later diseases of the farmers. Improper actions on the remaining pesti-
V.N. Huyen, N. Van Song and N.T. Thuy et al. Sustainable Futures 2 (2020) 100026

Table 8
Knowledge, awareness and behaviors of farmers when using plant protection drugs Unit:%.

The commune
specializing in rice
The communes specializing in vegetable production production
Criteria Hung Dao commune Ngoc Ky commune Average An Thanh commune

1. The knowledge of farmers on plant protection drugs

- Fully understand all drugs classified by harmful insects 34 47 40.5 39
- Understand toxicity on the label 15 9 12 21
- Understand the principle of 4 correct practices in the 13 12 12.5 9
use of plant protection drugs
- Understand the toxicity of the drugs 6 11 8.5 5
- Know prohibited and non-listed drugs 8 7 7.5 12
1. Situation of using labor protection equipment
- Regularly 79 83 81 75
- Sometimes 11 17 19 25
2. Method for handling excess drugs
- Try to spray all 92 97 94.5 87
- Pour down the ditch 3 0 1.5 8
- Pour into ponds 2 1 1.5 0
- Bring back to spray for other crops 3 2 2.5 5
- Pour in a specified place 0 0 0 0
3. Place for washing spraying equipment
- Any convenient place 97 89 93 94
- At the prescribed place 0 0 0 0
- Do not wash the bottle 3 11 7 6
4. Hygiene activities after spraying
- Rinse mouth after spraying 57 46 51.5 41
- Eye drops after spraying 15 12 13.5 11
- Spraying clothes are kept separately 73 78 75.5 83

Source: Compilation from survey data (2018).

Table 9
The proportion of common diseases of the farmers of Tu Ky district Unit:%.

Commune specializing in rice

The commune specializing in vegetable production production
Types of disease Hung Dao commune Ngoc Ky commune Average An Thanh commune

1. Otorhinolaryngologic 16.9 22.5 19.7 18.4

diseases
2. Eye diseases 26.8 21.3 24.05 26.5
3. Nervous system diseases 5.6 6.3 5.95 0
4. Dermatological diseases 29.6 22.5 26.05 22.5
5. Musculoskeletal diseases 5.6 8.7 7.15 10.2
6. Digestive diseases 11.3 16.3 13.8 10.2
7. Urologic diseases 0 1.2 0.6 2.0
8. Teeth - jaw – face diseases 4.2 1.2 2.7 10.2

Source: Compilation from survey data (2018).

cide can create many risks for the environment. In the case of farmers
dumping the leftover pesticides on the edge of the field, there are also
potential risks on farmers, caregivers and harvesters.
According to the habit of the farmers, it is often more convenient for
them to wash pesticide bottles and spraying tools in the nearby canals af-
ter spraying pesticides. More than 93.0% of the farmers in the commune
specialize in the production of vegetables and the commune specializes
in the production of rice wash bottles in canals, which is very dangerous
for shrimps and fish in ditches or animals grazing in the fields. There
are some households, for some reasons, could not wash the bottle after
spraying (more than 6%).
The results of the above analysis show that, due to the application of
a wide range of plant protection drugs, the common practice of mixing
too much drugs and then trying to using up the remaining drugs, or
using the excess drug of this vegetable to other vegetables and spraying
around the edge of the fields are dangerous not only to the farmers but
also to the local communities, consumers, and the society. It is necessary
to enhance the farmers’ knowledge of about the appropriate use of drugs,
to eliminate the phenomenon of mixing excess drugs, trying to use up
all the leftover or apply the remaining drugs of this vegetable to other
vegetables of the farmers.
4.3. Households’ awareness and behaviors before and after using plant
protection drugs
The study results showed that the knowledge about plant protec-
tion drugs of the surveyed households is still inadequate. According to
the classification by harmful insects and pests, plant protection drugs
consist of insecticides, pesticides, herbicides, rat poison, and growth
regulators. The percentage of households who know all kinds of plant
protection drugs is relatively low, only about 40%. Besides, farmers do
not understand the meaning of the colors on the packaging, and that
the contour running on the packaging represents the drug group. The
drug packaging is too small, so the portion of the color that determines
the remaining toxic content is very small, which is also the reason why
not many farmers understand the color of the printed bar announcing
the toxicity on the label. Specifically, in the communes specializing in
vegetable production, despite the regular use of plant protection drugs,
there is a lower proportion of farmers understanding the toxicity on la-
bels as compared to commune specializing in rice production (12% as
compared to 21%). Moreover, the percentage of farmers who correctly
and fully understand the principle of 4 correct practices in the use of pes-
ticides as well as recognize banned drugs and drugs not yet included in
V.N. Huyen, N. Van Song and N.T. Thuy et al.
the list of plant protection drugs permitted for use on rice and vegetable
crops is also very low. This showed that knowledge level of the farm-
ers about plant protection drugs is still limited. Farmers mostly focus
on eradicating harmful insects and diseases and do not pay attention to
the toxicity and the associated risks that plant protection drugs cause
to the environment and to the users themselves. This result implies that
the authorities need to focus on raising public awareness about plant
protection drugs.
Wearing labor protection equipment such as masks and gloves is
one of the safety principles when using the plant protection drugs. The
proper labor protection will help limit the adverse effects of plant protec-
tion drugs on human. Most farmers are aware of the importance of using
labor protection equipment when applying plant protection drugs. The
use of equipment such as masks, gloves, boots, glasses, hats, and rain-
coats helps farmers spray drugs more safely by avoiding direct contact
with plant protection drugs. However, the results showed that there are
still many cases of households rarely using these tools. The majority of
the interviewed farmers in Hung Dao commune (83%) often use labor
protection, while 25% of households in An Thanh commune occasion-
ally use labor protection. That is because An Thanh commune specializes
in rice production. Currently, the commune is using a pesticide spraying
machine on a large scale, and farmers are less exposed to the drugs than
the two communes specializing in vegetable production, so the use of
labor protection is also less common.
In An Thanh commune, farmers mainly grow rice, very little or al-
most no farmers grow vegetables. With the specific characteristics of
rice cultivation, pesticides are sprayed at certain times and on a large
scale. In An Thanh commune, the area of rice production is large and
concentrated, so farmers can use pesticide spraying machines, which
leads to increase productivity and limitation of the direct contact and
exposure of farmers to pesticides. Meanwhile, the vegetable production
areas are often small, unconcentrated, divided into many different types
of vegetables. That results in many difficulties in the application of pes-
ticide. Farmers still must spray the drugs directly. Therefore, the farmers
in communes producing rice are less exposed to pesticides than farmers
in communes producing vegetables.
At the same time, the regular exposure to plant protection drugs
also makes farmers in Hung Dao and Ngoc Ky communes become more
aware of the use of protective equipment. Thus, to ensure safety, farmers
need to improve their awareness of defense and functional departments
should further promote propaganda operation and provide farmers with
the needed knowledge o how to apply drugs effectively and safely.
Regarding the excess pesticides, most of the surveyed households
tried to use up all if the leftover pesticides with the proportion of the
farmers doing so in the commune specializing in vegetable production
is 94.5%, much higher than that of the commune specializing in rice
production (87%). Moreover, there are still many cases where farmers
dump excess drugs into ditches and ponds. In addition, farmers still have
the habit of washing bottles and spraying equipment wherever conve-
nient after finishing spraying. More than 93% of the surveyed farmers
in all 3 communes wash spraying bottles at canal and ditch. This is very
harmful to the environment, shrimp and fish living in ditches and ani-
mals grazing in the fields. In addition, this activity also greatly affects
the health of farmers because water from canals, ponds and lakes will in-
filtrate into the underground water source, potentially leading to many
diseases for farmers in the future.
The hygiene after pesticide application is also important to protect
drug users themselves. Activities such as using eye drops and mouth
rinses are essential because the mucous membranes of the eyes and
mouth are easily contaminated by the drugs. In the communes special-
izing in vegetable production, 51.5% of interviewees use mouth rinses
and 13.5% use eye drops after spraying. This proportion is lower in An
Thanh commune with 41% and 11% of households employing oral and
eye hygiene after using plant protection drugs. Up to 24.5% of the farm-
ers in the commune specializing in vegetable production and 17% of the
farmers in the commune specializing in rice production stills keep labor
Sustainable Futures 2 (2020) 100026
protection clothes with other clothes after spraying drug. This is very
dangerous when the clothes of other family members or daily outfits of
the drug user are in danger of indirect absorption of plant protection
products on protective clothing, leading to poisoning through the skin
and through contact with clothes. In general, the households are aware
of the importance of personal hygiene but the proportion is still low.
This suggests the critical role of extension officials and the mass me-
dia in guiding the use and handling of drugs after use as well as advis-
ing farmers to properly clean after spraying the plant protection drugs.
This result also sets out the need for the communal authorities to have
specific regulations on where to put pesticide packaging/containers, to
pour excess pesticides, and to wash pesticide spraying equipment so that
farmers can implement them properly, and to enhance training activi-
ties in order to ensure that they can fully understand the risks from their
own usage habits of pesticides.
4.4. Impacts of plant protection drugs on the health of farmers in Tu Ky
district, Hai Duong province
4.4.1. Common diseases of the farmers of Tu Ky district due to the use of
plant protection drugs
In Tu Ky district, the eye, skin, digestive, and otorhinolaryngologic
diseases are the most common diseases in the community. The diseases
of teeth - jaw - face, urology, and neuropathy accounted for lower pro-
portions. The percentage of farmers suffering from eye and dermatologi-
cal diseases is much higher than other diseases. Because of serious water
pollution, many farmers have pink eye which is often easily spread by
contact with infected farmers. The conducted interviews also showed
that many farmers had skin diseases and the possibility of recurrence
of this disease was very high because they were in direct contact with
plant protection products. On the other hand, the common practice of
keeping spraying clothes with daily clothes and the low proportion of
farmers cleaning their eyes and mouth after spraying drugs also make
farmers more susceptible to dermatological and eye diseases. The pro-
portion of interviewed farmers in Hung Dao commune with eye and
skin diseases is higher than the proportion in An Thanh commune. This
showed that the risk of these diseases is higher in the commune spe-
cializing in vegetable production than the commune specializing in rice
production. The number of farmers suffering from otorhinolaryngology
and digestion diseases in the study areas is adequately significant.
There are many cases of farmers passing through the spraying site
or inhaling plant protection drugs because they do not use masks while
spraying drugs, which contributes to the increase in the proportion of
farmers suffering from respiratory diseases. Besides that, the number of
farmers suffering from digestive diseases also accounts for not a small
proportion. The main reason is that farmers do not ensure daily sanita-
tion, because the use of domestic water is from wells and rainwater that
have not met the standard. In addition, the fact that farmers try to spray
all the plant protection drugs even when the amount of plant protec-
tion drugs they prepared exceeds the needed amount for their intended
crop areas leads to high residues in vegetables and fruits, resulting in
the possibility of poisoning for consumers. In addition, due to the habit
of littering pesticide packaging, washing spraying equipment or pouring
excess drugs directly into ponds and canals, the water on many rivers
and underground systems are, therefore, polluted. The health of farm-
ers who use these water sources is, as a result, negatively affected, such
as having digestive diseases. The study results showed that the propor-
tion of farmers suffering from digestive diseases in Ngoc Ky commune
is higher than the proportion of An Thanh commune, which once again
contributes to affirm that the percentage of farmers in the communes
specializing in vegetable production susceptible to digestive diseases is
higher than that of the commune specializing in rice production.
Because of the same natural, socio-economic and environmental con-
ditions, but diseases related to the use of plant protection drugs such as
Otorhinolaryngologic diseases, Eye diseases, Nervous system diseases,
Dermatological diseases, and Digestive diseases, farmers of Hung Dao
V.N. Huyen, N. Van Song and N.T. Thuy et al.
Table 10
The proportion of farmers having cancer in Hung Dao and Ngoc Ky communes as compared to Tu
Ky district.
In 2016
Commune
Number of farmers
Hung Dao commune 17
Ngoc Ky commune 14
Source: Compilation from survey data (2018).
Fig. 2. Mortality proportion due to cancer in the 2015 – 2017 period.
Source: Source: Compilation from survey data (2018).
and Ngoc Ky have significantly higher incidences of diseases, which is
especially Nervous system diseases.
4.4.2. The danger of cancer to the health of farmers in Tu Ky district
The International Agency for Research on Cancer, an intergovern-
mental agency forming part of the World Health Organization of the
United Nations, warns that herbicides and some plant protection drugs
that contain glyphosate can cause cancer. Hung Dao and Ngoc Ky com-
munes are the two communes with relatively high proportions of farm-
ers who produce crops using plant protection drugs. Cancer incidence
and deaths from cancer in the three years from 2015 to 2017 were rel-
atively high in the district. This is a dangerous sign that the health of
farmers there is increasingly declining.
Tu Ky district consists of 27 communes. According to the estimation
of the Health Center of Tu Ky district, in 2016 and 2017, the whole
district had a total of 525 farmers suffering from various cancers. The
proportion of farmers suffering from cancer in both Hung Dao and Ngoc
Ky communes in 2017 increased in comparison with 2016 and were
higher than those of other communes (Table 10). There are clear dif-
ferences in the numbers of deaths from cancer in the three study sites
(Fig. 2).
Through survey and data collection from the medical aid stations of
the 3 communes, it was found that the cancer death proportions in Hung
Dao and Ngoc Ky communes were much higher than that in An Thanh
commune (Fig. 2). Hung Dao and Ngoc Ky communes are also two typ-
ical communes with the highest death proportions from cancer in Tu
Ky district. Particularly, An Thanh commune is a pure rice production
commune. In recent years, the commune has developed rice production
combined with aquaculture. Over the past three years, the commune
has the lowest mortality proportion due to cancer in the whole district,
this is a good sign for the commune with its efforts in changing pro-
duction works and applying new equipment in pesticide application for
rice cultivation. For Hung Dao and Ngoc Ky communes, there are many
Sustainable Futures 2 (2020) 100026
In 2017
Percentage (%) Number of farmers Percentage (%)
6.9 32 11.5
5.7 26 9.3
causes behind the very high proportions of farmers dying from cancer.
We can see that the health care for farmers in these two communes is
still inadequate. Besides, the habit of using plant protection drugs in the
production of households still does not follow the principle of 4 “cor-
rect practices” (right drug, right dosage, right time, and right method).
In these two communes, most households still use domestic water as
the water source of untreated boreholes. This is a potential cause be-
hind farmers suffering from diseases caused by polluted plant protec-
tion water sources. According to the statistics of the National Institute
of Occupational and Environmental Health in Vietnam, currently, about
17.2 million farmers (equivalent to 21.5% of the population) are using
untreated water sources, which means that 17.2 million farmers are at
risk of diseases resulting from water pollution; annually, there are 9000
farmers die from poor water source and sanitation condition and, on
average, nearly 200,000 new cancer cases are discovered that one of
the main causes is water environment pollution. The cancers that this
group often have consist of cancer of the colon, nasopharynx, liver, and
lung. The cause of the disease is due to the use of arsenic-contaminated
water (untreated water) and daily plant protection drugs in a long time
which then penetrate the ground, into the groundwater, contaminating
groundwater while farmers here use groundwater for daily activities.
Some other households use rainwater, they collect rainwater in the early
summer for daily uses, this bad usage habit easily leads to farmers us-
ing water contaminated by plant protection drugs sprayed polluting the
air. Especially in the early rains, the possibility of rainwater still accu-
mulating many toxic chemicals that have not been resolved yet is high.
According to experts, the contamination of underground water is very
difficult to handle, and it is impossible to use the systems of conven-
tional water filtration. The daily use of water in bathing is extremely
dangerous or often leads to some skin diseases such as itching, gyneco-
logical infections in women, eye pain, worn nails, and toenails, etc. It
is worrisome that the disease situation becomes more and more serious
and can be poisoned, if this water source is used in the long term, it
can lead to many dangerous diseases such as cancer. In the immediate
future, while waiting for the authorities to resolve the problem, farmers
use the filter system of borehole water, register for installation and use
of clean water because this is a health problem that cannot wait.
The proportions of farmers dying from cancer in Hung Dao and Ngoc
Ky communes were 48.5% and 43.6%, respectively, much higher than
that of An Thanh commune (7.9%), which once again affirms that the
influence of plant protection drugs in communes specializing in veg-
etable production is more serious than in communes specializing in rice
production.
4.4.3. The impact of plant protection drugs on increasing medical
examination and treatment costs for farmers in Tu Ky district
The study used the Cost-of-Illness method to estimate the cost of
health examination of farmers in the study sites. The use of plant protec-
tion drugs affects human health, which has resulted in increased costs.
Expenses include medical expenses, health care costs, cost of leave,
and reduced labor productivity during sick days. When individuals pay
for hospitalization, medical expenses and other medical expenses, these
costs can be used to calculate the adverse health effects caused by the
degradation of environmental quality. Through the survey on the dis-
ease situation of farmers in the 3 study communes, we can see that
V.N. Huyen, N. Van Song and N.T. Thuy et al. Sustainable Futures 2 (2020) 100026

Table 11
Estimation and comparision Cost of Illness between communes specializing in vegetable production and specializing in rice production.

Comparison%
Criteria Unit Common Hung Dao Ngoc Ky An Thanh
Hung Dao/An Thanh Ngoc Ky/An Thanh

1. Population 1000 193,600 12,660.0 4530.0 8250.0 153.5 54.9

persons
2. Average number of members/household persons 3.52 3.6 3.5 3.6 101.1 97.5
3. Number of households in the commune households 3526.0 1309.0 2324.0 151.7 56.3
4. Number of sick times unable to work times 3.76 4.5 4.1 2.7 166.7 151.9
5. Number of sick days days 4.03 4.6 4.5 3.0 153.3 150.0
6. Average income/day 1000 VND 130 165.0 140.0 85.0 194.1 164.7
7. Average cost of treatment 1000 VND 170 197.0 185.0 130.0 151.5 142.3
8. The opportunity cost of households that 1000 VND 1969.8 3415.5 2583.0 688.5 496.1 375.2
could not work because of illness
9. The cost of treatment for each household 1000 VND 2576.0 4077.9 3413.3 1053.0 387.3 324.1
in the year
10. Cost of Illness (COI) 1000 VND 4545.8 7493.4 5996.3 1741.5 430.3 344.3
11. Extended Cost of Illness for Tu Ky District million 250,021.2
VND
Source: Compilation from survey data (2018).
Note: Exchange rate 23,500 VND = 1USD.

farmers mainly suffer from eyes, otorhinolaryngologic, dermatologic,
and digestive diseases, and cancer. The results of estimation and com-
parison between two communes specializing in vegetable production
(Hung Dao and Ngoc Ky) and commune specializing in rice production
(An Thanh) are shown in Table 11 below.
Although the daily income of farmers specializing in vegetable pro-
duction is 1.65 times higher (Ngoc Ky compared to An Thanh) - 1.94
times (Hung Dao compared to An Thanh), it is, in fact, a trade-off be-
tween high income and health for farmers.
Besides the cancer death rate of the two communes specializing in
vegetable production (Hung Dao and Tu Ky) being 4–5 times higher than
that of the commune specializing in rice production (An Thanh) (Fig. 2),
the COIs of farmers in two communes specializing in vegetable produc-
tion are remarkably higher than that of the pure rice production and
aquaculture communes (Table 11) represent cost. Opportunity costs re-
sulting from the loss of income due to the number of sick days of farmers
in Hung Dao and Ngoc Ky communes are 496% and 375% higher than
that of An Thanh, respectively. There are two reasons behind these dif-
ferences first, the income of farmers in 2 communes growing vegetables
and using more pesticides is generally higher; Second, the underlying
cause is a longer hospital stay due to a more serious illness (increase
from 50% to 70%, Table 11).
From the perspective of treatment costs, farmers in Hung Dao and
Ngoc Ky communes have a high treatment cost of 387% and 324% in
comparison with that of An Thanh commune. The main cause of the
treatment cost increased by more than 200% compared to the treatment
cost in An Thanh commune. The main cause of the high cost of treat-
ment is the higher treatment duration and higher unit costs due to more
severe illness (Tables 1, 3, 5, 7, 8, 9). The average Cost of Illness (COI)
of farmers in the surveyed communes is 4546 thousand VND (193USD)
per year. COI of farming households in Hung Dao and Ngoc Ky is 7493
thousand VND (318 USD) per year and 5996 thousand VND (255 USD)
per year as compared to 1742 thousand VND (74 USD) per year in An
Thanh, corresponding to 430% and 344% higher. The total COI of farm-
ers in Tu Ky district with 55,000 households is 250 billion VND per year
(10,638,300 USD per year) (Table 11).
4.5. Solutions to limit the impact of plant protection drugs on the health of
farmers in Tu Ky district, Hai Duong province
The study proposes some main solutions to reduce the impacts of
plant protection drugs on farmers’ health in Tu ky district, Hai Duong
province as follows:
(i) Increase training on the effects and minimize adverse effects of plant pro-
tection drugs on farmers’ health: For farmers, training activities will
help them acquire basic knowledge about plant protection drugs in
production, safe and effective usage techniques, the negative impacts
of plant protection drugs on the farmers’ health, the environment
and the future. The training helps farmers raise their awareness,
thereby changing their pesticide use and usage habits, which will
help to protect their health, the people around them as well as the
environment. In addition, the training activities should also be tar-
geted at the state managers and inspector officials through training
for local officials and technicians at the communal level. Besides,
the training for plant protection drug sellers is also necessary be-
cause it helps the pesticide store owners understand new laws and
regulations on pesticide trading.
(ii) Restrict the use of plant protection drugs: To apply basic production
methods such as field sanitation, root eradication, reasonable plow-
ing, crop rotation, intercropping, taking advantage of natural ene-
mies, using antibiotic varieties and following the farming schedule,
combining crop diversification, rotating crop varieties over years
to help improve productivity and limit the use of plant protection
drugs. To encourage and guide farmers to use self-made biological
preparations to eradicate harmful insects and diseases, which will
help minimize farmers’ exposure to plant protection drugs, reduce
negative impacts on the environment, and save production costs.
(iii) Increase the use of machinery, technical equipment in the process of ap-
plying plant protection drugs: The application of machines in the appli-
cation of plant protection drugs reduces the direct contact of sprayers
with plant protection drugs. Machines also reduce spraying time, la-
bor costs, and production costs.
(iv) Encourage farmers to join in and use health insurance: With a high pro-
portion of farmers suffering from common diseases and a high pro-
portion of farmers dying from cancer in communes specializing in
vegetable production, health insurance helps share risks for farmers.
Health insurance helps cover all or part of the cost of medical care,
helps patients and their families reduce financial burdens, overcome
illnesses and stabilize their lives.
(v) Focus on improving knowledge for householders, especially men be-
cause most of the householders and decision makers are male (ac-
counting for 57% - 61% as can be seen in Table 2), the householders
decide production methods including the amount of plant protec-
tion drugs, types of drugs, time, timing of application, method of
drugs infusion, and application method. If the householders have
more knowledge, they will have faster and more effective impacts
on the management and use of plant protection drugs.
 V.N. Huyen, N. Van Song and N.T. Thuy et al.
(vi) For the areas specializing in vegetable production, the following spe-
cific measures must be taken:
First, plan the vegetable cultivation into separate, specialized areas
for each type of vegetable. Do not intercrop vegetables because
intercropping often makes one type of vegetable affected by many
drugs, because each type of vegetable has its particular pests and
diseases; so intercropping means one type of vegetable being af-
fected by the plant protection drugs of the neighboring types of
vegetables.
Second, Agricultural extension in communes specializing in veg-
etable production (Ngoc Ky, Hung Dao) need to be more specific
than instructing farmers to mix drugs due to the more compli-
cated pesticide amount, type, dosage, time, timing and frequency
of pesticide application;
Third, it is necessary to enhance the knowledge of the use of drugs,
eliminate the practice of over-spraying, spraying up all the left-
over pesticides, spraying around the fields, using leftover pesti-
cides of one vegetable to other vegetables of the farmers.
Fouth, to pay special attention to training, raising knowledge and
investing in improving technology and techniques for vegetable
production areas. Because vegetables are often processed and
consumed immediately, the time to consumers is very short, so it
is necessary to help farmers understand the negative impacts of
pesticides not only on themselves, but also on the consumers and
the society in the short term and in the long term. It can be even
said that producers and consumers even pay for their lives when
using plant protection drugs and using agricultural products, es-
pecially vegetables. Therefore, farmers should harm themselves
and the society just for the immediate profit..
5. Conclusions
The fact that plant protection drugs have been applied not accord-
ing to instructions and not guaranteeing safety can lead to poisoning,
shock, seriously affect the health of farmers, and even result in death.
The study results showed that there are still many issues regarding the
awareness and habits of using pesticides of farmers in Tu Ky district,
Hai Duong province. Only 12% of farmers in the communes specializing
in vegetable production understand the toxicity on labels. The percent-
age of farmers using pesticides according to the principle of 4 correct
was only about 9–12%. The number of farmers who know the list of
banned pesticides is also very insignificant. The activities conducted af-
ter spraying pesticides also showed limited awareness of the farmers.
A vast majority (94.5%) of pesticide users in the commune specializing
in vegetable production try to spray all the drugs, and 93% of farm-
ers wash sprayer bottles right at the canals. The proportion of farmers
who have had proper hygiene after spraying drug is also not high. In
the commune specializing in vegetable production, 51.5% of intervie-
wees have rinse mouth and 13.5% have eye drops after spraying drugs.
These proportions decreased in An Thanh commune with 41% and 11%
of the households had oral and eye hygiene after using plant protec-
tion drugs, respectively. All these activities are the main reasons why
farmers’ health and living environment are affected by plant protection
drugs.
The impact of plant protection products is not only large but also
unpredictable; however, farmers do not have a comprehensive view of
the impact of pesticide use on their own health and those around them.
The analysis of the effects of plant protection drugs on the health of
farmers in Tu Ky district, especially the comparison between the com-
munes with different characteristics of crop production and the levels
of pesticide use, showed that pesticides seriously affect the health of
farmers, increase medical examination and treatment costs, cause can-
cer, and decrease life expectancy. The proportion of farmers suffering
from cancer in Hung Dao and Ngoc Ky communes has increased over the
years. The communes that use a lot of pesticides also have many more
Sustainable Futures 2 (2020) 100026
deaths due to cancer than communes with little use of plant protection
drugs. The proportion of farmers dying from cancer because of the use
of plant protection drugs in Hung Dao and Ngoc Ky communes were
48.5% and 43.6%, respectively, much higher than that of An Thanh
commune (7.9%), which confirms that the impact of plant protection
drugs in communes specializing in vegetable production is more serious
than communes specializing in rice production. COI of farming house-
holds in Hung Dao and Ngoc Ky is 7493 thousand VND (318 USD) and
5996 thousand VND (255 USD) as compared to thousand VND 1742
(74 USD) of An Thanh, corresponding to 430% and 344% of An Thanh’s
COI, respectively. The total COI of farming households in Tu Ky district
with 55,000 households is 250 billion VND per year (10,638,300 USD).
Based on the above results, the study proposed a number of solu-
tions for reducing adverse effects of plant protection drugs on farmers’s
health, including providing awareness-raising training for helping farm-
ers to gain basic knowledge about plant protection drugs and organiz-
ing technical training to help them use plant protection drugs safely
and effectively; restricting the use of pesticides by employing proper
production methods; using machinery and technical equipment in the
process of spraying plant protection drugs; encouraging farmers to par-
ticipate in buying and using pesticides to change their behaviors and
usage habits and minimize harmful effects of plant protection drugs on
the health of farmers. Specific planning for vegetable growing areas,
not intercropping and use interchangeably with plant protection drugs
kinds. The dosage, time, instance, method of spraying, behavior before,
during and after spraying of the producers should be carefully trained.
Encourage farmers to buy health insurance to share risks of disease.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
References
[1] S.A. Alam, H. Wolff, Do pesticide sellers make farmers sick? Health, information,
and adoption of technology in Bangladesh, J. Agric. Resour. Econ. 41 (1) (2016)
1–34 Western Agricultural Economics Association.
[2] K. Atreya, "Health costs from short-term exposure to pesticides in Nepal, Soc. Sci.
Med. 67 (4) (2008) 511–519 Elsevier.
[3] Bao Phuong, Dieu Thuy, Vietnamese habit: sticking to Chi-
nese goods, it has a bad global reputation, Vietnamnet (2018)
https://vietnamnet.vn/vn/kinh-doanh/thi-truong/nguoi-nong-dan-nghien-su-dung-
thuoc-bao-ve-thuc-vat-483931.html. (accessed February 12, 2019).
[4] S. Dasgupta, C. Meisner, N. Mamingi, "Pesticide traders’perception of health risks:
evidence from Bangladesh, Policy Research Working Paper Series 3777, The World
Bank, 2005.
[5] A. Dragomir, Consumption risks of pesticide-containing products, Internal Audit.
Risk Manag. 38 (1) (2015) 135–144 Athenaeum University of Bucharest.
[6] F.A. El-Motaleb, Integrated pest management, Open Access J. Environ. Soil Sci. 2
(5) (2019) 239 Lupine Publishers, LLC-239.
[7] F. Féménia & E. Letort, 2016. "How to achieve significant reduction in pesticide
use? An empirical evaluation of the impacts of pesticide taxation associated to a
change in cropping practice," Working Papers SMART - LERECO 16-02, INRA UMR
SMARTLERECO.
[8] F. Giannandrea, D.F. Iezzi, Effectiveness of interventions to assess the impact of
pesticides in the agricultural environment, J. Environ. 1 (1) (2014) 25–29 Asian
Online Journal Publishing Group.
[9] T. Khan, R. Ejaz, A. Khan, S. Bibi, Willingness to pay by the farmers for safer use of
pesticides, Asian Dev. Policy Rev. 6 (3) (2018) 169–177 Asian Economic and Social
Society.
[10] M. Khan, Economic Evaluation of Health Cost of Pesticide Use: Willingness to Pay
Method a, University Library of Munich, Germany, 2009 MPRA Paper 30178.
[11] M. Khan, Adverse Health effects, Risk Perception and Pesticide Use Behavior b, Uni-
versity Library of Munich, Germany, 2009 MPRA Paper 16276.
[12] Kieu Linh, VNECONOMY. “In 8 months, Vietnam spent nearly
300 million USD to import Chinese pesticides”, VnEconomy (2018)
http://vneconomy.vn/8-thang-viet-nam-chi-gan-300-trieu-usd-nhap-thuoc-tru-
sau-trung-quoc-20180830203640175.htm. (accessed February 12, 2019).
[13] J. Kim, A.C. Lee, Valuation of human deaths and illnesses resulting from pesticide
uses in the United States, in: Proceedings of the Annual meeting, July 23-26, Long
Beach, CA 21172, American Agricultural Economics Association (New Name 2008:
Agricultural and Applied Economics Association), 2006.
V.N. Huyen, N. Van Song and N.T. Thuy et al.
[14] H. Klemick, E. Lichtenberg, Pesticide use and fish harvests in vietnamese rice agroe-
cosystems, Am. J. Agric. Econ. 90 (1) (2008) 1–14 Agricultural and Applied Eco-
nomics Association.
[15] W. Lai, Pesticide use and health outcomes: evidence from agricultural water pol-
lution in China, in: Proceedings of the Annual Meeting, July 31-August 2, Boston,
Massachusetts 235439, Agricultural and Applied Economics Association, 2016.
[16] W. Lai, Pesticide use and health outcomes: evidence from agricultural water pollu-
tion in China, J. Environ. Econ. Manag. 86 (C) (2017) 93–120 Elsevier.
[17] M. Lamers, M. Anyusheva, N. La, V.V. Nguyen, T. Streck, Air pollution in water and
water surface due to wet producing rice: a case study in Northern Vietnam, Clean
Soil, Air, Water 39 (4) (2011) 356–361.
[18] I. Macharia, D. Mithöfer, H. Waibel, Health effects of pesticide use among vegetable
farmer in Kenya, in: Proceedings of the Fourth International Conference, Septem-
ber 22-25, 2013, Hammamet, Tunisia 160471, African Association of Agricultural
Economists (AAAE), 2013.
[19] B.M. Maumbe, S.M. Swinton, Hidden health costs of pesticide use in Zimbabwe’s
smallholder cotton growers, Soc. Sci. Med. 57 (9) (2003) 1559–1571 Elsevier.
[20] N. Moehring, S. Gaba, R. Finger, Quantity based indicators fail to identify extreme
pesticide risks, in: Proceedings of the Conference, July 28-August 2, 2018, Vancou-
ver, British Columbia 277363, International Association of Agricultural Economists,
2018.
[21] Phuong Mai, 2020. “Events and comments. alarming the abuse of
plant protection drugs in our country today”. Nam Dinh Newspaper.
http://baonamdinh.com.vn/channel/5097/201907/bao-dong-tinh-trang-lam-dung-
thuoc-bao-ve-thuc-vat-o-nuoc-ta-hien-nay-2531680/index.htm (accessed February
12, 2019).
Sustainable Futures 2 (2020) 100026
[22] F. Quarcoo, C. Bonsi, D.N.O. Tackie, W.A. Hill, G. Wall, G. Hunter, Economies of
scale in integrated pest management in vegetable and fruit production, Profess.
Agric. Workers J. (PAWJ) 5 (1) (2017) 53–68 Professional Agricultural Workers
Conference.
[23] B.P. Resosudarmo, Pesticides and policy: the impact of integrated pest management
on the Indonesian economy, EEPSEA Policy Brief pb2001101, Economy and Envi-
ronment Program for Southeast Asia (EEPSEA), Revised Oct 2001, 2001.
[24] P. Schreinemachers, M. Wu, M.N. Uddin, S. Ahmad, P. Hanson, Farmer training in
off-season vegetables: effects on income and pesticide use in Bangladesh, Food Policy
61 (C) (2016) 132–140 Elsevier.
[25] S.E. Sexton, Z. Lei, D. Zilberman, The economics of pesticides and pest control, Int.
Rev. Environ. Resour. Econ. 1 (3) (2007) 271–326.
[26] Statistical Office of Tu Ky District, 2019. “Annual statistical report”.
[27] C.M. Travisi, P. Nijkamp, R.J.G.M. Florax, A Meta-Analysis of the Willingness to Pay
for Reductions in Pesticide Risk Exposure, FondaKhanzione Eni Enrico Mattei, 2004
Working Papers2004.101.
[28] H. Waibel, H. Garming, Pesticides and farmer health in Nicaragua: a willingness to
pay approach, in: Proceedings of the German Development Economics Conference,
Göttingen 2007 7, Verein Für Socialpolitik, Research Committee Development Eco-
nomics, 2007.
[29] C. Wilson, C. Tisdell, "Why farmers continue to use pesticides despite environmental,
health and sustainability costs, Ecol. Econ. 39 (3) (2001) 449–462 Elsevier.
[30] A. Żak, Plant protection products versus changes in the natural environment and
their impact on the human health, Problems of Agricultural Economics 249741, In-
stitute of Agricultural and Food Economics - National Research Institute (IAFE-NRI),
2016.