Occupational Pesticide Exposure and Parkinsonism Symptoms Among Highland Vegetable Farmers in North Sumatra, Indonesia: A Cross-Sectional Study

Suriati Lubis; Dwi Ris Hasanah S

doi:10.70716/mohr.v3i3.762

Authors

Suriati Lubis Midwifery Academy, Darmo College of Health Sciences, Medan, Indonesia
Dwi Ris Hasanah S Midwifery Academy, Darmo College of Health Sciences, Medan, Indonesia

DOI:

https://doi.org/10.70716/mohr.v3i3.762

Keywords:

pesticides, parkinsonian disorders, occupational exposure, personal protective equipment, agricultural workers

Abstract

Chronic pesticide exposure is an established environmental risk factor for parkinsonian syndromes, yet evidence from Southeast Asian smallholder agriculture is scarce. This community-based cross-sectional study examined the prevalence of Parkinsonism symptoms and modifiable occupational determinants among 102 pesticide-applying farmers in Juhar District, Karo Regency, North Sumatra, Indonesia. Parkinsonism symptoms were screened using an adapted Unified Parkinson's Disease Rating Scale motor checklist (Cronbach α = 0.89). Exposure intensity, personal protective equipment (PPE) use, and post-application hygiene were assessed through structured interviews. Associations were tested using chi-square analysis and crude odds ratios (OR) with 95% confidence intervals (CI). Screening-positive Parkinsonism symptoms were identified in 36 farmers (35.3%; 95% CI 26.2–45.2), including resting tremor, bradykinesia, rigidity, and postural instability. High spraying frequency (OR = 7.1; 95% CI 2.7–18.9; p = 0.001), inconsistent PPE use (OR = 4.7; 95% CI 1.8–12.0; p = 0.002), and inadequate hygiene (OR = 7.5; 95% CI 2.5–22.0; p < 0.001) were all strongly associated with symptom positivity. One in three pesticide-applying farmers screened positive for Parkinsonism symptoms in this highland horticultural community, with strong associations to modifiable occupational behaviours. Findings support integrated occupational-health action including subsidised PPE, farmer education, restriction of highly hazardous pesticides such as paraquat, and neurological screening at primary care.

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References

Ahmed, M., Zafar, M., Ali, F., & Khan, S. (2023). Neurobehavioral dysfunctions among pesticide-exposed farm workers: Evidence from Pakistan. Environmental Research, 231, 116042. https://doi.org/10.1016/j.envres.2023.116042

Ball, N., Teo, W.-P., Chandra, S., & Chapman, J. (2019). Parkinson's disease and the environment. Frontiers in Neurology, 10, 218. https://doi.org/10.3389/fneur.2019.00218

Ben-Shlomo, Y., Darweesh, S., Llibre-Guerra, J., Marras, C., San Luciano, M., & Tanner, C. (2024). The epidemiology of Parkinson's disease. The Lancet, 403(10423), 283–292. https://doi.org/10.1016/S0140-6736(23)01419-8

Christy, L. D., Veerapan, V., & Jayakrishna, J. T. (2024). Association between occupational pesticide exposure and Parkinson's disease risk: An observational study in the South Indian population. Current Trends in Biotechnology and Pharmacy, 18(2), 1657–1665.

Collins, L. M., O'Reilly, É. J., Osayande, J. O., Wilson, F., Nwachukwu, I., & Abraham, J. (2025). Investigating awareness of pesticide exposure as a risk factor for Parkinson's disease and uptake of exposure-mitigating behaviour in farming communities. Safety, 11(2), 49. https://doi.org/10.3390/safety11020049

Dorsey, E. R., & Bloem, B. R. (2024). Parkinson's disease is predominantly an environmental disease. Journal of Parkinson's Disease, 14(3), 451–465. https://doi.org/10.3233/JPD-230357

GBD 2021 Neurology Collaborators. (2024). Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23(4), 344–381. https://doi.org/10.1016/S1474-4422(24)00038-3

Gonzalez, L. A., Ramirez, P., & Morales, J. (2022). Parkinsonism symptoms in banana plantation workers in Central America. International Journal of Occupational Medicine and Environmental Health, 35(4), 445–457. https://doi.org/10.13075/ijomeh.1896.01892

Innos, J., & Hickey, M. A. (2021). Using rotenone to model Parkinson's disease in mice: A review of the role of pharmacokinetics. Chemical Research in Toxicology, 34(5), 1223–1239. https://doi.org/10.1021/acs.chemrestox.0c00522

Killinger, B. A., Melki, R., Brundin, P., & Kordower, J. H. (2022). Endogenous alpha-synuclein monomers, oligomers and resulting pathology. NPJ Parkinson's Disease, 8, 44. https://doi.org/10.1038/s41531-022-00318-7

Kwon, H.-S., & Koh, S.-H. (2020). Neuroinflammation in neurodegenerative disorders: The roles of microglia and astrocytes. Translational Neurodegeneration, 9, 42. https://doi.org/10.1186/s40035-020-00221-2

Malla, B. S. S. M., & Kattamreddy, A. R. (2024). A case for banning paraquat in India: A public health concern. The National Medical Journal of India, 37(1), 34–37.

Neupane, D., Jørs, E., & Brandt, L. (2023). Pesticide use, self-reported symptoms and biomarkers among smallholder farmers in Nepal. International Journal of Environmental Research and Public Health, 20(4), 2891. https://doi.org/10.3390/ijerph20042891

Nguyen, T., Bui, Q., & Pham, L. (2023). Parkinson's-like symptoms among rice farmers in Vietnam. PLOS ONE, 18(4), e0283456. https://doi.org/10.1371/journal.pone.0283456

Paul, K. C., Krolewski, R. C., Lucumi Moreno, E., et al. (2023). A pesticide and iPSC dopaminergic neuron screen identifies compounds associated with Parkinson's disease. Nature Communications, 14, 2803. https://doi.org/10.1038/s41467-023-38215-z

Petit, P., Berger, F., & Bonneterre, V. (2025). Investigating Parkinson's disease risk across farming activities. NPJ Parkinson's Disease, 11, 15.

Pouchieu, C., Piel, C., Carles, C., et al. (2023). Pesticide use in agriculture and Parkinson's disease in the AGRICAN cohort. Occupational and Environmental Medicine, 80(4), 200–208. https://doi.org/10.1136/oemed-2022-108541

Ramadhan, A., Syahailatua, A., & Wouthuyzen, S. (2023). Environmental exposure and public health in Indonesian agricultural zones. Penerbit BRIN.

Shrestha, S., Kamel, F., Umbach, D. M., et al. (2019). Nonmotor symptoms and Parkinson disease in United States farmers and spouses. PLOS ONE, 14(12), e0226206. https://doi.org/10.1371/journal.pone.0226206

Sitanggang, A. H., Hutagalung, J. P., & Sembiring, Y. (2024). Health risk assessment of pesticide application among North Sumatran vegetable farmers. Jurnal Kesehatan Masyarakat Sumatera, 9(1), 55–61.

Thapa, R., Manandhar, A., & Adhikari, S. (2023). Parkinsonism among pesticide-exposed farmers in the Terai region of Nepal. South Asian Journal of Neurology, 5(2), 135–142.

von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2020). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. International Journal of Surgery, 12(12), 1495–1499.

Wan, N., & Lin, G. (2022). Parkinson's disease and pesticides exposure: New findings from a comprehensive study. Environmental Research, 204, 112380. https://doi.org/10.1016/j.envres.2021.112380

Yang, C., Lin, X., Wang, Y., et al. (2023). Occupational pesticide exposure and Parkinson's disease: A systematic review and meta-analysis. Environmental Research, 238, 117184. https://doi.org/10.1016/j.envres.2023.117184

Yuliani, R., Sudrajat, A., & Maulani, M. (2022). The role of PPE and pesticide handling behavior on farmer health in Central Java. Jurnal Kesmas Indonesia, 18(3), 127–134. https://doi.org/10.14710/kesmas.v18i3.13477