Factors associated with cholinesterase levels among farmers


  • Juntarawijit Y Faculty of Nursing, Naresuan University
  • Juntarawijit C Faculty of Agriculture Natural Resources and environment, Naresuan University
  • Chaichanawirote U Faculty of Nursing, Naresuan University
  • Rakmeesri P Faculty of Nursing, Kamphaeng Phet Rajabhat University
  • Yaowapanon N McCormick Faculty of Nursing, Payap University, Chiang Mai


cholinesterase, pesticides exposure, insecticide, farmer health


Objectives The objective was to explore the prevalence of abnormal cholinesterase (ChE) levels among farmers, and its associated factors.

Methods This study was a cross-sectional study. The sample were 1,944 farmers in Phitsanulok, Thailand. Participants were randomly selected using a multistage sampling. Data were collected by using a face-to-face interview questionnaire. Demographics, the historical use of pesticides, data on knowledge, attitude, and practice on exposure prevention were also collected. Cholinesterase levels were measured using a reactive-paper finger-blood test. Correlation of risk factors to the prevalence of abnormal ChE among farmers were analyzed by binary logistic regression and multiple logistic regression.

Results It was found that 61.9% of the participants had abnormal PChE, defined as having risky and unsafe levels. The prevalence of abnormal PChE was significantly correlated to sex, education, and frequency of farm visits. Compared to the rarely visited group, participants who visit a farm every week (adjusted OR 1.70, 95% CI 1.16-2.49) and every day (adjusted OR 1.74, 95% CI 1.21-2.51) had a higher risk of abnormal PChE. The result revealed that spraying, duration of insecticide usage, knowledge, attitude, and practice were not associated with PChE.

Conclusion This study found over half of the farmers had abnormal ChE. The abnormality was significantly linked to several risk factors, including sex, education, and frequency of farm visits. Therefore, preventive measurements of pesticide exposure are needed to protect the farmers.


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1. National Statistical Office, Ministry of Digital Economy and Society. Summary of working status of population, February 2020. 2020. [cited 2021 Feb 15] Available from http://www.nso.go.th/sites/2014/Pages/home.aspx
2. Office of Agricultural Economics. Agricultural economics data. 2018 [cited 2021 Feb 15] Available from http://oaezone.oae.go.th/view/1/%E0%B8%9B%E0%B8%B1%E0%B8%88%E0%B8%88%E0%B8%B1%E0%B8%A2%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B8%9C%E0%B8%A5%E0%B8%B4%E0%B8%95/TH-TH
3. Bureau of Occupational and Environmental Diseases. Knowledge on Screening of risk of pesticide exposure by using Cholinesterase reactive paper for health personnel in primary care unit. Bangkok: Kaewchomkhwan Printing media Center, Suan Sunandha Rajabhat University; 2017. (in Thai)
4. Juntarawijit C. Harmful effects of pesticides. Phitsanulok: Kanpim.com; 2018. (in Thai)
5. Zafarzadeh A, Mirkarimi SK, Bay A, Heidari A. Determinants of farmers’ health behaviors on poisoning with pesticides in Golestan Province: based on the health belief model. J Res Dev Nurs Midwifery. 2019;16:41-51.
6. Lu JL. Comparison of pesticide exposure and physical examination, neurological assessment, and laboratory findings between full-time and part-time vegetable farmers in the Philippines. Environ Health Prev Med. 2009; 14:345-52.
7. Buralli RJ, Ribeiro H, Iglesias V, Muñoz-Quezada M, Leão RS, Marques RC, Almeida MMC, Davée Guimarães JR. Occupational exposure to pesticides and health symptoms among family farmers in Brazil. Revista de Saúde Pública. 2020;54:1-12.
8. Kim KH, Kabir E, Jahan SA. Exposure to pesticides and the associated human health effects. Sci Total Enviro. 2017;575:525-35.
9. Division of Occupational and Environmental Diseases. Report of occupational and environmental diseases. 2018. [cited 2021 Feb 15] Available from http://envocc.ddc.moph.go.th/uploads/situation2/2561/2561_01_envocc_situation.pdf
10. Division of Occupational and Environmental Diseases. Situation of diseases problems and health effects related to pesticide. n.d. [cited 2021 Feb 15]. Available from http://envocc.ddc.moph.go.th/contents/view/404
11. Chuenchom T. Factors Associated with the Farmers’ Blood Cholinesterase Level. Reg 4-5 Med J. 2018;37:86-97. (in Thai)
12. Jantasuwan R, Jaraeprapal U. The Relationships between Knowledge, Self-management Behavior for Pesticide Protection into the Body and Serum Cholinesterase Level among Farmers in Khao Pra Bath Sub-district, Nakhon Si Thammarat Province. Journal of Faculty of Nursing Burapha University. 2019;27:68-77. (in Thai)
13. Prado-Lu JLD. Pesticide exposure, risk factors and health problems among cutflower farmers: a cross sectional study. J Occup Med Toxical. 2007;2:1-8.
14. Mahidol University, Faculty of Medicine Ramathibodi Hospital, Ramathibodi Poison Center.Toxicity of Organophosphates and Carbamates. [cited 2021 Mar 10]. Available from https://med.mahidol.ac.th/poisoncenter/th/pois-cov/OP_CB (in thai)
15. Phitsanulok provincial agricultural extension office. Basic information. 2021. [cited 2021 Mar 1]. Available from http://www.phitsanulok.doae.go.th/?page_id=25
16. Phitsanulok provincial agriculture and cooperatives office. Phitsanulok farmers, Produce quality products, produce consumer food safety. 2020. [cited 2021 Feb 25]. Avaliable from https://www.opsmoac.go.th/phitsanulok-article_prov-preview-421091791873 (in thai)
17. Pidgunpai K, Keithmaleesatti S, Siriwong W. Knowledge, attitude and practice associated with cholinesterase level in blood among rice farmers in Chainart province, Thailand. J Health Res, 2014;28:93-99. (in thai)
18. Bureau of Occupational and Environmental Diseases. Occupational health services for health personel handout: Farmer health clinic. 3rd ed. Nonthaburi: Agricultural Co-operative Federation of Thailand; 2015. (in Thai)
19. Thammarat R, Polprasarn P, Jantasuwan R. Knowledge and Safe Consumption Behavior of Vegetables and Fruit from Pesticides and Serum Cholinesterase Levels in Pregnant Women, Nakhon Si Thammarat Province. Royal Thai Navy Medical Journal. 2020;47:659-71. (in thai)
20. Chaiklieng1 S, Praengkrathok S. Risk assessment on pesticide exposure by biological monitoring among farmers: a case study in Tambon Kangsanamnang, Nakhonratchasima Province. Srinagarind Medical Journal. 2013:28:382-9. (in Thai)
21. Santaweesuk S, Boonyakawee P, Siriwong W. Knowledge, attitude and practice of pesticide use and serum cholinesterase levels among rice farmers in Nakhon Nayok Province, Thailand. Journal of Health Research. 2020;34:379-87. (in thai)
22. Andrea G, Thepaksorn P, Neitzel RL. Prevalence of Abnormal Serum Cholinesterase and Associated Symptoms from Pesticide Exposure among Agricultural Workers in the South of Thailand. J Agromedicine. 2018;23:270-8.
23. Kachaiyaphum P, Howteerakul N, Sujirarat D, Siri S, Suwannapong N. Serum cholinesterase levels of Thai Chilli-Farm workers exposed to chemical pesticides: prevalence estimates and associated factors. J Occup Health. 2010; 52:89-98. (in thai)
24. Tawatsin A, Thavara U, Siriyasatien P. Pesticides used in Thailand and toxic effects to human health. Med Res Arch. 2015;3:1-10. (in thai)
25. Punkhun S, Norkaew S, Kesornthong S. Factors related to enzyme cholinesterase of tobacco famers: a case study in Sukhothai Province. Dis Control J. 2017;43;270-9. (in Thai)
26. Kapeleka JA, Sauli E, Sadik O, Ndakidemi PA. Biomonitoring of acetylcholinesterase (AChE) activity among smallholder horticultural farmers occupationally exposed to mixtures of pesticides in Tanzania. J Environ Public Health. 2019;11:2019:3084501.



How to Cite

Y J, C J, U C, P R, N Y. Factors associated with cholinesterase levels among farmers. Chiang Mai Med J. [Internet]. 2021 Oct. 1 [cited 2022 May 25];60(4):629-41. Available from: https://he01.tci-thaijo.org/index.php/CMMJ-MedCMJ/article/view/253951



Original Article