ESTIMATING UNDERREPORTED PESTICIDE POISONINGS IN NICARAGUA

We undertook to estimate the degree of underreporting to a regional pe sticide poisoning registry, and to estimate the true incidence of pois oning in apr agricultural region of Nicaragua. We surveyed 633 workers at 25 of 33 agricultural cooperatives and any nearby private farms in a area geographically convenient to the regional health headquarters with a short structured interview about pesticide poisonings. Eighty-t hree percent of workers described current use of pesticides. Twenty-fi ve percent described a pesticide poisoning in the preceding 12 months, and almost one-half (48%) described having been made ill by pesticide s at some point in time. Sixty-nine (11%) described a poisoning in the preceding month, 23 of whom had received medical attention. The names of the medically treated were sought in the Regional Pesticide Poison ing Registry for the survey year of 1988. Only 8 of the 23 subjects we re found reported to the registry when a total of 1,143 human pesticid e poisonings were reported in the entire region. Using 65% as an estim ate of underreporting to the registry, we calculate that 3,300 (95% Cl 2100-7500) poisonings had received treatment in the region in 1988, o f whom more than 2,100 remained unreported Based on the ratio of total poisonings (treated and untreated) to registry-reported poisonings am ong our survey respondents, we estimate that 6,700 (95% Cl 4100-18000) systemic poisonings, occurred in 1988 in the region. Underreporting o f pesticide poisonings disguises the enormity of the problem in develo ping countries. Even in a region with a strong emphasis on illness rep orting for targeted conditions, underreporting is substantial. This me thod for estimating underreporting is easily applied and provides a ro ugh estimate of registry underreporting and actual incidence for condi tions identifiable by a community-applied questionnaire. (C) 1996 Wile y-Liss, Inc.