Determinants of Pesticide Exposure Among Cotton Farmers in Côte d'Ivoire: A Mixed-Methods Cross-Sectional Study in Toumoukoro Sub-Prefecture
Abstract:
Cotton farmers in
sub-Saharan Africa face considerable pesticide exposure risks, yet behavioural
determinants remain insufficiently documented through approaches combining
self-reported and directly observed data. This study identified structural
determinants of pesticide exposure among cotton farmers in Toumoukoro
sub-prefecture, northern Côte d’Ivoire, and measured the gap between declared
and observed behaviours. A cross-sectional mixed-methods design integrated a
quantitative phase (structured questionnaire, N = 315, stratified random
sampling from 19,562 producers across 13 villages) and a qualitative phase
(direct non-participant observation, N = 68). Statistical analyses included
odds ratios (OR), relative risks (RR), numbers needed to treat (NNT), Fisher’s
exact test, and 95 % confidence intervals. All producers used pesticides
(100 %), and 95.9 % reported at least one symptom after application (OR absence
of PPE vs symptoms = 35.9; NNT = 10.3). Access to personal protective equipment
(PPE) was limited for 89.2 % of producers, with cost as the dominant barrier
(OR cost/unavailability = 100.4). Training was associated with higher
self-reported PPE use (OR = 1.96) but produced no measurable behavioural effect
in direct observation (Fisher p = 1.000 for all PPE items). Risk
underestimation was reported by 64.8 % of producers, and 87.6 % perceived
pesticide use as socially normalized in their community. Pesticide exposure
results from four interdependent structural determinants: economic barriers to
PPE access, social normalization of risk, behavioral ineffectiveness of current
training, and productivist pressure toward overdosing. Simultaneous action
across all four axes is required to durably reduce exposure and associated
morbidity.
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