Obstructive Lung Disease Linked to Occupational Exposures in Malawian Tobacco Farmers.

Introduction : Nicotine and pesticide exposure in agricultural settings have been linked to the development of chronic respiratory disease in workers. However, this has not been extensively studied in Africa. The aim of this study was therefore to determine the prevalence of obstructive lung disease and its relationship to concurrent nicotine and pesticide exposure among small-scale tobacco farmers in Malawi. For this purpose, sociodemographic characteristics, occupational and environmental exposures were evaluated in relation to work-related respiratory symptoms and lung function impairment. Methods : A cross-sectional study was conducted enrolling 279 workers in flue-cured tobacco farms in Zomba, Malawi. The study instruments used for assessing the health outcomes were a standardised European Community Respiratory Health Survey II (ECRHS) questionnaire and Spirometry testing. The questionnaires were aimed at collecting relevant data on sociodemographic factors and self-reported respiratory health outcomes. Data were also collected on potential pesticide and nicotine exposures. Spirometry was done to evaluate for objective respiratory impairment in accordance with American Thoracic Society guidelines. Results : The mean age of participants was 38 years with 68% being male. The prevalence of work-related ocular nasal symptoms, chronic bronchitis, and work- related chest symptoms was 20%, 17%, and 29%, respectively. Airflow limitation (FEV1/FVC <70%) was found in 8% of workers. Self-reported exposure to pesticide varied from 72%- to 83 %, whilst the prevalence of recent green tobacco sickness was 26%. Tasks linked to nicotine exposure, such as sowing (OR: 2.5; CI 1.1-5.7)), harvesting(OR: 2.6;CI 1.4 -5.1) were significantly associated with work-related chest symptoms. Pesticide application (OR:1.96;CI 1.0- 3.7) was associated with an increased risk of work-related occulonasal symptoms Duration of pesticide exposure was also associated with obstructive impairment FEV1/FVC<LLN (OR: 5.11; CI 1.6-16.7) and FEV1/FVC<70% (OR: 4.68; CI 1.2-18.0). Conclusions : This study demonstrated that tobacco farmers in Malawi had a high prevalence of respiratory symptoms and airflow limitation due to obstructive lung disease. This could be attributed to nicotine or pesticide exposure in small scale tobacco farming. The implementation of occupational health and safety measures to mitigate these exposures may play an important role in modifying the risk of obstructive lung disease in this population.