An epidemic of pesticide poisoning in Nicaragua: implications for prevention in developing countries.

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Abstract
OBJECTIVES. The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings. METHODS. Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals. RESULTS. During June and July 1987, an epidemic of 548 pesticide poisoning was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of age. CONCLUSIONS. Unsafe working conditions such as manual application of pesticides and the use of backpack sprayers, the introduction of a hazardous powdered formulation of carbofuran highly restricted in the developed world, and agricultural subsidies that encouraged the use of hazardous pesticides all contributed to the epidemic.

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