Relationship of Pesticide Exposure with Hypertension for Farmers in

Juhar District, Karo Regency in 2019

Rio Ferdi Yuandra

, Taufik Ashar

, Rahayu Lubis

,and Fithri Handayani Lubis

Public Health Faculty, Universitas Sumatera Utara, Jl. Universitas No. 21 Kampus USU, Medan 20155, Indonesia

Public Health Faculty, Health Institute of Deli Husada Deli Tua, Jl. Besar Deli Tua No. 77, Deli Serdang, Indonesia

Keywords: Pesticide Exposure, Hypertension, Karo District

Abstract: Hypertension or high blood pressure is an increase in abnormal blood pressure in the arteries, also known as

"silent killer", risk factors for hypertension is sex, gen, smoking, obesity, cholinestrase, excessive use of

pesticides can cause poisoning that is decreased cholinesterase activity which can cause hypertension. In

2018, hypertension is the third highest disease in the Juhar, where the majority of the population works as

farmers (88.54%). The purpose of this study was to analyze the relationship pesticide exposure with

hypertension in farmers in Juhar District, Karo District in 2019. This study was quantitative study with cross

sectional research design. Data obtained through interviesws with questionnaires and blood pressure

checked. The results of the study of 35 farmers sampled were 14 people (40%) had hypertension. Chi-

square test results showed that there was a relationship between the duration of spraying (p= 0.094),

spraying techniques (p= 0.034), the use of personal protective equipment Self (p= 0.041) with hypertension,

while years of service (p= 0.685) had no relationship with hypertension. The public health center has an

active role in providing counseling, periodic hypertension checks. It is suggested to Ministry of Agriculture

to monitor and supervise the use of pesticides in farmers, and for the farmers to pay attention in using

personal protective equipment, spraying techniques, and not spray more than 4 hours/day.

1 INTRODUCTION

Based on World Health Organitation (2015), there

are around 1.13 billion people in the world suffering

from hypertension, it is estimated that 1.5 billion

people will be affected by hypertension in 2025, and

every year 9.4 million people die from hypertension

and complications (Ministry of Health, 2018) .

In Indonesia, based on Riskesdas data (2018), the

prevalence of hypertension in the population aged

≥18 years was 34.1% and an increase of 8.3% from

2013. The highest prevalence occurred in South

Kalimantan (44.1%) and the lowest in Papua

(22.2%). Data from Riskesdas (2013), hypertension

in North Sumatra, the highest hypertension sufferers

were in Karo District at 37.5%, afterwards Humbang

Hasundutan and Gunung Sitoli.

Profile of the Karo District Health Office, the

number of cases of hypertension were ranked third

with the highest incidence in the Karo District

Health Center with a total of 13,689 cases (11.84%).

The Juhar public health center report found that in

October 2018 hypertension was the 3rd highest

disease out of the 10 highest disease lists in the

Juhar public health center with 135 cases. In 2013

the prevalence of hypertension in Indonesia was

recorded at 25% occurred in the group of farmers /

fishermen (Riskesdas, 2013).

Hypertension is also known as a silent killer

(silent killer) because patients suffering from

hypertension are usually not accompanied by

complaints or symptoms. In general, people who

suffer from hypertension just know that they suffer

from hypertension after complications occur

(Ministry of Health, 2013).

The risk factors for hypertension are gender,

obesity, smoking habits, diabetes mellitus, and

cholesterol levels in the body.

In general it is estimated that hypertension is

found twice as much in the diabetic population

compared to non-diabetics. Hypertension is known

to accelerate and aggravate complications due to

diabetes such as coronary heart disease, stroke,

diabetic nephropathy, diabetic retinopathy, and

cardiovascular disease due to diabetes, which

doubles when accompanied by hypertension.

262

Yuandra, R., Ashar, T., Lubis, R. and Lubis, F.

Relationship of Pesticide Exposure with Hypertension for Farmers in Juhar District, Karo Regency in 2019.

DOI: 10.5220/0009472602620269

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 262-269

ISBN: 978-989-758-460-2

Hypertension is a major factor in life expectancy and

complications in diabetic patients and determines the

evaluation of nephropathy and retinopathy of

diabetics in particular.

One of the causes of hypertension is insulin

resistance/hyperinsulinemia. The association of

primary hypertension with insulin resistance has

been known for several years, especially in obese

patients. Insulin is a suppressor because it increases

levels of ketekolamin and sodium reabsorption. The

relationship between diabetes and hypertension is

more complex and is not related to nephropathy. In

diabetic patients, hypertension is often part of the

metabolic syndrome of insulin resistance.

Hypertension may appear for several years in these

patients before diabetes mellitus appears.

Hyperinsulinemia enhances the pathogenesis of

hypertension by decreasing sodium excretion in the

kidneys, stimulating activity and tissue response to

the sympathetic nervous system, and increasing

vascular surrounding resistance through vascular

hypertrophy. The active management of

hypertension (<130/80 mmHg) reduces the

development of macrovascular and microvascular

complications.

Pesticides on the body can cause various

negative effects on health. Several studies have

identified these effects, and found to affect various

organ systems, especially the nervous system

according to Wiadi (2017). There are various factors

that can increase blood pressure. Factors that can

trigger high blood pressure are behavioral factors

such as unhealthy food, tobacco use, physical

activity and use of hazardous substances, metabolic

factors such as obesity, diabetes, and excess fat in

the blood and cardiovarscular disease factors such as

coronary heart disease, stroke, and kidney disease

(WHO, 2013).

Apart from these basic risk factors,

environmental toxic substances including pesticides

can also affect new risk pathways such as

inflammation and oxidative stress. Environmental

poisons can be considered as an important risk factor

for cardiovascular disease. There is a relationship

between pesticide exposure and cardiovascular

outcomes, there is a contribution of pesticides to

cardiovascular disease (Wahab, A., et.al. 2016).

Agriculture is the sector that absorbs the most

labor in Indonesia. In increasing agricultural yields,

it is necessary to complete agricultural facilities

including agricultural equipment, artificial fertilizers

and chemical additives including pesticides

(Ministry of Agriculture, RI, 2013). Farmers tend to

use pesticides not according to indications of pest

control, but rather to use them continuously without

regard to indications for their use.

The use of excessive and uncontrolled quantities

of pesticides will pose a risk of poisoning to farmers.

The effects of pesticides depend on the dose of

pesticides, the length of time of exposure and

exposure modification factors such as the use of

Personal Protective Equipment according to

Hohenadel K (2011). There is a significant

relationship between age, sex, years of service, and

the use of personal protective equipment with the

incidence of hypertension (Louisa, 2018). There is a

relationship between the history of exposure to

pesticides with farmers' blood pressure found that

farmers with abnormal cholineterase levels have a 2-

fold increased risk of systolic pressure (Zulfania,

2017).

The community has been working as farmers for

around 10-30 years with a spraying time of around

2-8 hours / day. Farmers spraying do not use masks

and headgear when working with reasons not

comfortable and are not accustomed.

The Juhar Community Health Center Monthly

Report is known that in October 2018 there were

135 cases of hypertension. Based on interviews with

health complaints to 30 farmers, information is

obtained that there are 4 people who have narrowed

heart arteries, 9 people have high blood pressure

(hypertension), 6 people have diabetes mellitus, and

8 people have Hb levels (hemoglobin) in under

normal. In addition, all farmers interviewed had

other health problems such as itching, low back

pain, dizziness, fatigue and weakness, and some

farmers experienced complaints of frequent

urination at night. Therefore, researchers want to

examine whether there is a relationship between

pesticide exposure with the incidence of

hypertension in farmers in Juhar District, Karo

Regency.

2 RESEARCH METHOD

This type of research is quantitative research with

cross sectional design. Research that emphasizes the

measurement or observation of data at one time is

carried out on the dependent variable and the

independent variable. Research locations in Juhar

sub-district, Karo District, from January to May

2019. The population in this study were all farmers

living in Juhar District, with a sample of 35 farmers.

Data Collection Methods Using Primary data

obtained from interviews with respondents using

questionnaires to obtain data on pesticide exposure

Relationship of Pesticide Exposure with Hypertension for Farmers in Juhar District, Karo Regency in 2019

263

and blood pressure checks of respondents. Blood

pressure measurements were performed by Juhar

Community Health Center nurses using a

Spigmomanometer. Secondary data were obtained

from data from the Juhar District Health Center in

Karo District, Karo District Health Office, North

Sumatra Province Health Office and other

supporting data in this study.

Analyzed univariately to get a picture presented

in the form of a frequency distribution table,

bivariate is conducted to determine the relationship

between two variables, namely the independent

variable and the dependent variable using the

statistical test, Chi-square test, multivariate is done

to determine the strength of the relationship between

the independent variable and the dependent variable

using the Logistic Regression test.

3 RESEARCH RESULTS AND

DISCUSSION

Juhar is a sub-district located in Karo Regency

which has an area of 23.14 km2 with an area of 852

Ha of agricultural land. The population in Juhar

District is 2,611 people. Based on data from the

Karo Regency Central Statistics Agency (2017), the

number of people employed is 1817 with 1578

people (86.84%) working as farmers.

The results showed that there were 27 farmers who

had worked for more than 5 years or (22.9%).

Farmers who sprayed less than 4 hours / day were 19

people or 54.3%. Farmers spray poorly, as many as

17 people or (48.6%). There were 18 people who

were good at using personal protective equipment or

(51.4%). There are 21 hypertensive farmers (60%).

This is shown in the Table 1.

Table 1: Characteristics of respondents.

Variable n (%)

Sex

Male 22 62,9

Female 13 31,7

Body mass index

Normal 28 80,0

Obesity 7 20,0

Smoking

No Smoking 20 57,0

Smoking 15 42,0

Lengh of work

≤ 5 years 8 22,9

> 5 years 27 77,1

Spraying duration

≥4 hour a day 16 45,7

<4 hour a day 19 54,3

Spraying technique

Not good 22 62,9

Good 13 37,1

Personal Protective

Equipment Using

Not good 17 48,6

Good 18 51,4

Hipertention

Normal 14 40,0

Hipertention 21 60,0

The analysis of the relationship of the

independent variable with the dependent variable

showed that there was a relationship between the

variable of spraying time, spraying technique, the

use of personal protective equipment with

hypertension with a p value <0.05, but there was no

relationship between working period with

hypertension.

The analysis of the relationship between the

independent variable and the dependent variable

showed that there was a relationship between the

variable spraying time, spraying technique, the use

of personal protective equipment with hypertension

with a p value <0.05, but there was no relationship

between sex, body mass index, smoking habits, and

length of service with hypertension with p > 0.05.

This is shown in the Table 2.

Table 2: Relationship of Individual Characteristics, Working Period, Exposure Time, Spraying Technique, Use of Personal

Protective Equipment with Hypertension in Farmers in Juhar District, Karo Regency.

Variable

Hipertention

p OR

Yes % No % Total %

Sex

Male 10 45,4 12 54,5 22 100,0 0,392 1,875

Female 4 30,8 9 69,2 13 100,0

Body mass index

Normal 13 46,4 15 53,6 28 100,0 0,203 5,200

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

264

Obesity 1 14,3 6 85,7 7 100,0

Smoking

No Smoking 6 30,0 14 70,0 20 100,0 0,163 0,375

Smoking 8 53,3 7 46,7 15 100,0

Lengh of work

≤ 5 years 4 50,0 4 50,0 8 100,0

0,685 1,700

> 5 years 10 37,0 17 63,0 27 100,0

Spraying duration

≥4 hour a day 9 56,3 7 43,8 16 100,0

0,094 3,600

<4 hour a day 5 26,3 14 73,7 19 100,0

Spraying technique

Not good 12 54,4 10 45,5 22 100,0

0,034 6,600

Good 2 15,4 11 84,6 13 100,0

Personal Protective Equipment

Using

Not good 10 58,8 7 41,2 17 100,0

0,041 5,000

Good 4 22,2 14 77,8 18 100,0

Multivariate analysis in this study used a

logistic regression test. After bivariate analysis of

all independent variables, the independent

variables are entered into multivariate analysis

with criteria if they have a p value of <0.05 and

become an important variable in this study. The

independent variables that meet these criteria are

as follows in Table 3.

Table 3: Multivariate analysis of hypertension logistic regression among farmers in Juhar District, Karo District.

Variabel Koefisien (B) p OR

95% C.I.for EXP(B)

Lower Upper

Step

Body mass index 1,676 0,247 5,345 0,313 91,259

Smoking -1,240 0,180 0,289 0,047 1,777

Spraying duration 0,927 0,328 2,526 0,395 16,170

Spraying technique 2,153 0,042 8,608 1,084 68,331

Personal Protective

Equipment Using

1,230 0,196 3,423 0,530 22,117

Constant -4,324 0,161 0,013

Step

Body mass index 1,784 0,191 5,952 0,410 86,507

Smoking -1,358 0,138 0,257 0,043 1,545

Spraying technique 2,019 0,045 7,534 1,043 54,442

Personal Protective

Equipment Using

1,577 0,077 4,841 0,843 27,784

Constant -4,148 0,153 0,016

Step

Smoking -1,151 0,176 0,316 0,060 1,676

Spraying technique 2,011 0,043 7,468 1,061 52,556

Personal Protective

Equipment Using

1,678 0,050 5,353 1,002 28,607

Constant -0,456 0,506 0,634

Step

Spraying technique 1,863 0,045 6,446 1,042 39,895

Personal Protective

Equipment Using

1,586 0,050 4,883 0,999 23,873

Constant -0,925 0,125 0,396

Step

Personal Protective

Equipment Using

1,887 0,032 6,600 1,176 37,028

Constant -0,182 0,670 0,833

3.1 Relationship between Gender and

Hypertension

In the gender variable, it is known that farmers who

are male are 22 people (62.9%) and women are 10

people (31.7%). The results of the analysis of the

relationship between sex and hypertension note that

there is no relationship between sex and

hypertension in farmers in Juhar District with a

value of p> 0.05 or p = 0.392. Based on the results

Relationship of Pesticide Exposure with Hypertension for Farmers in Juhar District, Karo Regency in 2019

265

of this study it is known that men and women can

suffer from hypertension and everyone has the

opportunity to suffer from hypertension depending

on lifestyle and other factors that can be at risk for

hypertension.

This study is in accordance with

Prasetyaningrum (2014) that men or women are

equally at risk of developing hypertension compared

to women at age <45 years, but at the age of> 65

years women are more at risk of developing

hypertension. The results of this study are not in

accordance with research conducted by Amanda

(2018) where the results in the study showed a

relationship between sex variables with the

incidence of hypertension.

3.2 Relationship of Body Mass Index

with Hypertension

In the body mass index variable it is known that

farmers who have a normal body mass index are 38

people (80.0%) and obesity are 7 people (20%). The

results of the analysis of the relationship between

body mass index and hypertension can be seen that

there is no relationship between body mass index

and hypertension in farmers in Juhar District with a

value of p> 0.05 or p = 0.203. Farmers with normal

weight and excess weight can suffer from

hypertension and if examined more deeply each

person has the opportunity to suffer from

hypertension depending on lifestyle and other

factors that can be at risk for hypertension.

The results of this research are in accordance

with Sundari research (2015) showing that there is

no relationship between obesity and the incidence of

hypertension in Karang Anyar Village with a p-

value> 0.05. The results of the analysis found that

the proportion of hypertensive patients who are not

obese more than obese hypertensive patients. The

results of this study are not in accordance with

Estiningsih's (2017) study where the results of the

study conducted showed a significant relationship

between normal body mass index and excess body

mass index in hypertensive respondents.

3.3 Relationship between Smoking and

Hypertension

In the smoking habit variable it is known that there

are 20 non-smoking farmers (57%) and 15 smoking

people (42%). The results of the analysis of the

relationship between smoking and hypertension can

be seen that there is no relationship between

smoking and hypertension in farmers in Juhar

District with a value of p> 0.05 or p = 0.187.

Farmers with active or passive smoking habits can

suffer from hypertension and if examined more

deeply everyone has the opportunity to suffer from

hypertension depending on lifestyle and other

factors that can be at risk for hypertension.

The results of this research are in accordance

with Rinawang's (2017) research, that smoking is

not one of the risk factors of hypertension, based on

statistical tests conducted showed that there is no

significant relationship between smoking and the

incidence of hypertension. The absence of a

relationship between smoking and the incidence of

hypertension is likely due to hypertension sufferers

who have never smoked had a history of exposure to

cigarettes or smoke. The results of this research are

not in accordance with Sundari's study (2015) which

shows that there is a relationship between smoking

and the incidence of hypertension in Karang Anyar

Village with a value of p = 0.04. This is because

carbon monoxide in cigarette smoke will also

replace oxygen bonds in the blood, resulting in

increased blood pressure because the heart is forced

to pump enough oxygen to enter the organs and

other body tissues.

3.4 Relationship of Length of Work

with Hypertension

In the variable of length of work, it is known that

farmers with more than 5 years of service are 27

people or (22.9%) and less than 5 years are 8 people

or 22.9%. Based on the analysis of the relationship

between work period and hypertension, it can be

seen that there is no relationship between work

period and hypertension in farmers in Juhar District

with a value of p> 0.05 or p = 0.685, farmers who

work for more than 5 years and farmers who have

worked less than 5 years are equally at risk for

suffering from hypertension depending on the

lifestyle of the person, the person's behavior and

other factors. Exposure to pesticides does not always

directly have a significant impact on the human

body without causing sudden pain, chronic

poisoning is more difficult to detect because it is not

immediately felt and does not cause specific

symptoms and signs. However, chronic poisoning

for a long time can cause health problems.

Multivariate results showed different results

where the duration of spraying had no effect on

hypertension with a p value = 0.328.

The results of this study are the same as the

research conducted by Maarif (2016) where the

results state that there is no significant relationship

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

266

between work period and low levels of

cholinesterase in farmers because farmers do not

carry out agricultural activities continuously, there

are times when farmers do not carry out agricultural

activities. The length of time needed for

cholinsterase levels to return to normal depends on

the type and level of poisoning itself. In addition, the

level of cholinesterase in the blood can return to

normal if it considers good nutritional status.

The results of this research are not in accordance

with Louisa's research (2018) which states that there

is a relationship between work period and the

incidence of hypertension with a p value = 0.017.

The longer a person becomes a farmer, the more

possibilities for contact with pesticides.

3.5 The Old Relationship between

Spraying and Hypertension

In the spraying variable it is known that farmers who

sprayed less than 4 hours per day were 19 people or

(54.3%) and farmers who sprayed more than 4 hours

per day were 16 people or (45.7%). The results of the

analysis of the relationship between duration of

spraying with hypertension can be seen that there is a

relationship between spraying time with hypertension

in farmers in Juhar District with a value of p <0.05 or

p = 0.094 and an odd ratio value of 3.600. Farmers

who spray ≥ 4 hours per day will tend to be at risk of

experiencing hypertension 3,600 times compared to

farmers who spray <4 hours per day.

Based on interviews, information was obtained

that farmers often sprayed on large enough areas and

had to be completed within the same time, that is, in

1 day so pests and weeds that interfere with petati

plants could be exposed to pesticides simultaneously

to avoid pests and weeds resistant to pesticides .

Spraying pesticides with a spraying time of more

than 3 hours without a break will result in chronic

poisoning. Farmers when spraying do not use

personal protective equipment so pesticides can be

directly exposed to the body of farmers which can

increase the risk of exposure.

This study is in line with Prasetya et al, (2017)

revealed that the duration of spraying has an

influence with hypertension. spraying farmers who

exceed the safe time limit then in the long run can

have an impact on hypertension. If the spraying time

of farmers is still within the safe time limit of 1-3

hours, then poisoning due to pesticides can still be

reduced, usually symptoms of pesticide poisoning

appear after 4 hours of exposure. The longer the

farmer is exposed to pesticides, the greater the risk

that the farmer will experience poisoning. The

results of this study are not in accordance with

Louisa's research (2018) which states that there is a

relationship between the duration of exposure to the

incidence of hypertension with a value of p = 0.12.

3.6 Relationship between the Use of

Personal Protective Equipment and

Hypertension

In the variable of personal protective equipment

usage it is known that farmers who use personal

protective equipment poorly as many as 17 people

(48.6%) and farmers who use personal protective

equipment well as many as 18 people or 51.4%. The

results of the analysis of the relationship between the

use of personal protective equipment and

hypertension can be seen that there is a relationship

between the use of personal protective equipment

and hypertension in farmers in Juhar District with a

value of p <0.05 or p = 0.041 and an odd ratio value

of 5,000. Farmers who use personal protective

equipment poorly will tend to be at risk of

hypertension 5,000 times compared to farmers who

use personal protective equipment well.

The results of this study note that more than 50%

of farmers use personal protective equipment well,

but there are still many farmers who do not wear

long sleeves and long pants, there are still minimal

farmers who always use masks when spraying, in the

application of pesticides still very few use gloves

hands when mixing or when spraying. Pesticides are

generally contact poisons, so the use of personal

protective equipment for farmers when spraying is

very important to avoid direct contact with

pesticides.

3.7 Relationship of Spraying

Technique with Hypertension

In spraying technique variables, it is known that

farmers who are not good at spraying are 22 people

(62.9%) and farmers who are good at spraying are

13 people or (37.1%). The results of the analysis of

the relationship between spraying techniques with

hypertension can be seen that there is a relationship

between spraying techniques with hypertension with

a value of p <0.05 or p = 0.034 and an odd ratio

value of 6.600. Farmers who spray poorly will tend

to be at risk of experiencing hypertension 6,600

times compared to farmers who spray well.

This result is strengthened by multivariate

analysis in which the spraying technique variable has

an influence on hypertension with a value of p =

0.043.

Relationship of Pesticide Exposure with Hypertension for Farmers in Juhar District, Karo Regency in 2019

267

In this study it can be seen that more than 50% of

farmers apply spraying techniques in the

unfavorable category. Farmers when spraying do not

pay attention to correct techniques such as not

walking backward in spraying, do not pay attention

to the direction of the wind, and do not pay attention

to spraying time. The application of pesticides is

often sprayed, which allows the liquid pellets to

drift, deviating from the application. The distance

traveled by the liquid granules depends on the size

of the granules. Grains with a radius smaller than

one micron can be considered as gases whose

infinite velocity settles, while grains with a larger

radius will settle faster.

This study is not in accordance with research

conducted by Agustina (2018) where there is no

relationship between the management of pesticides

with the incidence of hypertension with a value of p

= 0.959.

Multivariate results obtained from the use of

personal protective equipment have no effect with a

value of p = 0.05. The results of this study are in

accordance with research conducted by Louisa

(2018) there is a relationship between the use of

personal protective equipment and the incidence of

hypertension with a p value = 0.015. The use of

personal protective equipment on farmers is very

important to avoid direct contact with pesticides.

The use of personal protective equipment can reduce

the possibility of direct contact with pesticides so

that the risk of pesticides entering the body through

the respiratory, digestive and skin areas can be

avoided.

p =

1+e

p = 84,4%

Based on the above equation it is known that if

farmers with spraying techniques have the

opportunity to experience hypertension by 84,4%

and hypertension caused by other factors not

included in this research variable by 15,6%.

4 CONCLUSIONS

4.1 Conclusion

There was a relationship between the spraying

technique (p = 0.034), the use of Personal Protective

Equipment (p = 0.041) with hypertension, while the

length of service had no relationship with

hypertension. Spraying techniques have the

opportunity to experience hypertension by 84,4%

and hypertension caused by other factors not

included in this research variable by 15,6%.

4.2 Suggestion

The public health center has an active role in

providing education and knowledge to farmers about

the dangers and impacts of pesticide use. Create

programs aimed at monitoring the health of farmers

by conducting periodic checks. Being considered by

the Health Service and the Agriculture Service to

make policies and programs related to the use of

pesticides properly and in accordance with

procedures.

Farmers are expected not to spray more than 4

hours/day to avoid over-exposure to pesticide

chemicals so that farmers avoid pesticide poisoning.

Farmers are expected to pay attention to spraying

techniques, pay attention to wind direction and walk

backwards in spraying and using personal protective

equipment in full such as using long-sleeved clothes,

long pants, masks, gloves, hats and boots.

ACKNOWLEDGEMENTS

This research was supported by Health Institute of

Deli Husada, Health Institute of Medistra Lubuk

Pakam, Sembiring General Hospital Foundation, and

Medistra Foundation, Indonesia.

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