Economic burden of illness from pesticide poisonings in highland Ecuador.
Active surveillance of acute pesticide poisonings in a potato-growing region of highland Ecuador during 1991-1992 uncovered a rate of 171/100,000, due predominantly to occupational exposures to organophosphate and carbamate pesticides. Occupational exposure among agricultural workers was the most common reason for poisoning (32 male workers and 1 female worker, out of a total of 50 cases). Of these 33 cases, 28 of them reported pesticide application as the work task just prior to poisoning, with over 80% citing the use of World Health Organization Hazard Category I pesticides. The suicide rate of 17.1/100,000 and the overall mortality rate of 20.5/100,000 that we found are among the highest reported anywhere in the world. At the exchange rates prevailing at that time, median costs associated with these poisonings were estimated as follows: public and social security health care direct costs of US$ 9.85/case; private health costs of US$ 8.33/case; and lost-time indirect costs of US$ 8.33/agricultural worker. Each one of those costs was over five times the daily agricultural wage, which was then about US$ 1.50. Further costing of pesticide poisonings should be carried out in other settings to provide appropriate information for decisions about pesticide use. In addition, integrated pest management should be further evaluated as an appropriate technology to reduce the economic burden of illness from pesticide poisonings in developing countries.