Use of personal protective equipment in agricultural workers under hot and humid conditions.

health effects of a hot environment on outdoor workers at a construction site 1) and thermal limits of men in moderate to heavy work in tropical farming 2). Both studies highlighted the importance of heat stress for outdoor workers and the implementation of administrative and engineering controls to reduce heat stress exposure. Our interest in this topic is in relation to agricultural workers in tropical environments who have multiple occupational exposures and who must rely on personal protective equipment (PPE), in the absence of higher level control strategies. Among different economic activities, agriculture is placed as one of the most hazardous industries 3). Working in hot climates may lead to dehydration and heat exhaustion which can cause acute-or chronic-illnesses, and in some cases death. Severe dehydration was observed in many Nicaraguan banana plantation workers and their children 4). Importantly, chronic dehydration seems to increase the risk of urolithiasis 5) , and dehydration combined with heat, heatstroke and hyperthermia is directly related to increased mortality 6). The annual death rate caused by heat in agricultural industry is 20-fold higher than that for all civilian workers in the USA 7). Furthermore, dehydration and exhaustion caused by heat can adversely affect worker productivity, safety and behavior. Another hazard is pesticide exposure which can result in acute and chronic adverse health effects 8, 9). Despite the obvious importance of PPE and the knowledge that correct usage and good personal hygiene reduce occupational pesticide exposures, PPE use is still not extensive. In developed countries, guidelines and regulations for pesticide use including the appropriate application of PPE are well documented and established, but similar support may not be expected in developing countries. A combination of climate and economic issues limits PPE use in less developed nations. Climate factors such as high humidity and temperature make the use of PPE very uncomfortable , especially respirators, face masks and overalls. It is obvious that high humidity and temperatures are not favorable working conditions but in combination these factors affect the attitude and behavior among agricultural workers resulting in reduced PPE use. A recent study on Californian farmers 10) showed the complexity of the PPE issue when they observed a significant reduction in the use of dust masks or respirators over a prolonged period of time. Although low education and income are recognized as contributing factors to limiting PPE use, this study showed the workers' perception of health risks …