Correlational Analysis with Regards to the Causes of Chemical Intoxication Due to Pesticides Among Farmers in Bogotá, Colombia: A Cross-Sectional Observational Study

Reviewer Comment

Reviewer response

Modification (page and line number)

Line 13: "Severe" and "chronic" are two categories that are not opposite to each other. What you probably wanted to say is "severe acute and chronic intoxications". That would make sense and would be correct.

Thank you. It is modified according to the suggestion. 

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Line number: 13

Line 22: Should be 32%

Thank you. The percentage (%) is added to the number 32.

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Line number: 22

Line 24: Instead of "product", the more appropriate term is "result".

Thank you. The word "product" is changed to "result"

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Line number: 24

Line 36: "Industry" sounds a bit odd here, as "agriculture" is often considered the opposite of "industry." Perhaps "economy" is a more appropriate term.

Thank you. It is modified according to the suggestion.

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Line number: 34 - 35

Line 38: "plague" is, for most, associated with a specific disease (ie., bubonic or lung plague). What you mean here, is "pests" (as an overall term for fungi, insects, weeds etc. - therefore, the substances are called "pesticides").

Thank you. It is modified according to the suggestion.

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Line number: 37

Line 38: What do you mean with "combined"? Do you want to highlight a particular risk of pesticide mixtures or do you mean "use in parallel"? Could be useful to be a bit more specific.

Thank you. The term "combined" is maintained, since this is the use at the academic level, but the purpose of mixing pesticides and their potential risk is explained.

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Line number: 37,38, 39

Line 41: I guess that the estimate of NIH is not related to but based on various studies...

Thank you. The estimate of the National Institute of Health is modified, reporting the average number of cases and percentage of pesticide poisoning for a period of time from 2017 to 2022. The report of cases comes from the collection of information made by the institute from the epidemiological surveillance systems implemented by the country.

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Line number: 40, 41, 42, 43, 44

Table 1: I would suggest to move this table to the subsection on "Study areas" below. Otherwise, there would be questions about Ciudad Bolivar, Bogotá D.C etc.

Thank you. The table is moved to the end of the introduction, in this way there is a contextualization from the general (Colombia) to the particular (Bogotá – Ciudad Bolivar)

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Line number: 99 - 100

Line 55: For a foreigner, it is difficult to swallow that pesticide intoxications were a major challenge in a city. From the discription, however, it seems that "Bogotá" is more than a city but also a rural area with agriculture. Perhaps you can explain that a bit.

Thank you. The description of the rurality of Bogotá is expanded and a connection is made with the locality of Ciudad Bolivar and its importance at the agricultural level for the city.

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Line number: 75 to 86

Research design, Line 80: Of course, it is not a mistake but is it really necessary to repeat the numbers in brackets? I have seen that in the abstract, too. The editor might decide on this practice. I consider it very unusual.

Thank you. Parenthetical numbers are removed in the abstract and research design so that it is not redundant

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Line number: 23 - 158

Line 81: "Manipulation" should be rather "handling" of pesticides

Thank you. It is modified according to the suggestion.

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Line number: 159

Line 84: What is a "referent"? A "reference"? The latter would make sense, if you have adapted a research design for your purposes. Also "y" should be "and", I guess.

Thank you. The word "referent" mentions that these investigations were the bibliographic source to adapt the tool or questionnaire that was used in the research, in this way the section is rewritten.

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Line number: 162 - 163

Line 103/104: I must confess not to have understood your approach with regard to women and children because 112 farmers (mostly men, I assume) were included but not their families. Please clarify.

Thank you. The section is rewritten mentioning that it was possible to survey 10% of the population that has been in contact with pesticides, taking into account that 1048 people live in the area, but of this total many are women dedicated to household activities and children who do not have contact with pesticides. Therefore, family members of farmers were not included.  The following paragraph Line 179-183 explains the type of population under study. 

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Line number: 179 to 183

Line 127: Can you give some reference where "Kobo Collect application" is described? If not, you should briefly explain it. I have never heard about it...

Thank you. The description of "Kobo Collect application" is expanded

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Line number: 220 to 223

Line 135: "6% were women." ("corresponded to women" sounds strange...)

Thank you. It is modified according to the suggestion.

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Line number: 238

Results, line 173: What is the "new general sample"? The 98 farmers in direct contact with pesticides (better here than "chemicals")? Please clarify.

Thank you. The expression "new general sample" refers to the 98 people who had contact with pesticides. In this way, the idea is rewritten to clarify.

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Line number: 293 - 294

Lines 173/174: Does that mean that only 22% were involved in mixing activities whereas the others applied "ready to use" formulations? But, on the other hand, you say that "not everyone made mixtures". Could be also read in the sense that 78% made the mixtures but 22 did not. Please clarify and check also Figure 2 for this purpose.

Thank you. It is clarified, improving the wording, that 22% of the surveyed population is not involved in pesticide mixing activities. Figure 2 is also reviewed, which is in accordance with the statement that was improved in the wording. The presentation of Figure 2 is improved.

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Line number: 293 - 294

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Line number: 313 - 314

Lines 178: In contrast to the lines before, 72% and 62% must not be set in brackets. 

Thank you. It is modified according to the suggestion.

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Line number: 298

Line 187-190: The term "condition" is unusual and clearly defined. "Disease", "symptoms" or "impairment" would be perhaps more appropriate. 

Thank you. It is modified according to the suggestion and the term condition is changed to disease. The repeated term "condition" was eliminated

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Line number: 317 to 319

Line 188: Compared to other papers on adverse health outcomes of pesticide exposure, the neurological, dermal (not "dermic") or respiratory symptoms are not surprising and well known from other parts of the world. What surprises me is the very high percentage of visual "conditions". Was it eye irritation or more an impairment of the visual sense? Could be useful to distinguish. 

Thank you. In the case of visual impairments, it is not possible to differentiate between eye irritation or an alteration in visual acuity, since the questionnaire did not make a difference in this regard, but the comment were taken into account to enrich the discussion on this aspect.  

Line number: 438 to 457

Line 237: If we assume that eye irritation was of concern, it is surprising that protective equipment for the eyes had no effect. Any explanation for that?

Thank you. Of course, visual conditions have a high % of reports by people who are in contact with pesticides and can be prevented with the use of eye protection elements, but it should be taken into account that the event analyzed is poisoning, which is always related to gastric symptoms.  for example, nausea and vomiting and neurological level, for example, hallucinations, loss of consciousness, dislocation, among others. Therefore, poisoning is not associated with eye damage and therefore personal protection elements are not significant for people at the time of poisoning. 

Line number: 438 to 457

Discussion, Lines 269/270: "Exposition of pesticides" is the wrong term. Should be "exposure to pesticides".

Thank you. It is modified according to the suggestion

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Line number: 408

Line 271: Should be simple "... aspects that make it possible to contribute to identification of occupational risks for farmers." As it is, it sounds very complicated.

Thank you. It is modified according to the suggestion.

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Line number: 408 - 409

Line 282: If it is about "mixing", more than one chemical should be involved. Better, therefore: "... before the use of agrochemicals ( pesticides? ) or their mixing".

Thank you. It is modified according to the suggestion.

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Line number: 419

Lines 287-299: This  might be the most appropriate place to discuss the frequent observation of eye symptoms in your study. Seems to differ from the findings of other researchers.

Thank you. A paragraph was included mentioning that eye symptoms or diseases, which differ from the report of other studies, is a new opportunity for research in Colombia, since the pesticides used in the country have been related to this type of affectation.

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Line number: 438 to 457

Conclusions, lines 347-350: It might be a good idea to combine the two sentences. "... agricultural sector because of socio-demographic conditions..."

Thank you. The first idea of the concluding paragraph is rewritten according to the suggestion

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Line number: 504 to 507

Line 359: "guarantee" may be a too good word. If safety could be increased, much would have been won.

Thank you. It is modified according to the suggestion

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Line number: 525 - 526

Comments on the Quality of English Language: In principle, English is fine and understandig the text is easy but the use of some words appears a bit unusual and they could be replaced by more appropriate terms. This is at least my impression but English is not my mother tongue as well. I have tried to make some suggestions. On balance, the paper would clearly benefit of proof reading by a native speaker who is also familiar with scientific English.

Thank you. We appreciate the different corrections he gave us about the language, which were accepted and of course we will take into account the revision of a native speaker for the general correction of the language

It is evident throughout the article.

Reviewer Comment

Reviewer response

Modification (page and line number)

Introduction: I suggest improving the description of the limits of literature and data on the topic you are addressing and what your work should add.  

Thank you. The introduction was improved in terms of writing and ilation of ideas. Therefore, the limitation of the study is much clearer by mentioning the generality of poisonings in the country and their relationship with the phenomenon of poisoning in the city of Bogotá and the town of Ciudad Bolivar throughout 2017 to 2022. In addition, the purpose of the research and contribution is clarified.

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Section: Introduction

Methods: The data reported from LINE 100 to LINE 105 AND LINE 130 to LINE 140, including Table 2, should be considered results, and I suggest moving these lines to the results section.

Thank you. Lines 100 to line 105 are kept in the methodological design section, as the sampling process that was carried out is explained. If we move the sociodemographic description to the results section.

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Line number: 235 to 289

Results: see previous point

Thank you. Lines 100 to line 105 are kept in the methodological design section, as the sampling process that was carried out is explained. If we move the sociodemographic description to the results section.

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Line number: 235 to 289

Discussion: rewording the sentences from line 336 to line 345.

Thank you. Sentences were rewritten as per the suggestion

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Line number: 492 to 497

Conclusion: Avoid the repetition of percentages and improve the generalisability of the results to other competitions and the suggestions for further studies given in the last sentences.

Thank you. Percentages have been removed. The results were generalized. The conclusions are concluded by mentioning future studies oriented to the agricultural sector.

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Line number: 502 to 542

At the end of the revision process, please revise the abstract to align it with the final version of the manuscript.

Thank you. We checked that the abstract was aligned with the rest of the article

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Line number: 12 to 26

Comments on the Quality of English Language: The English language is acceptable, but some passages could be clarified, so a review of the final version by professional language editing services is recommended.

Thank you. We appreciate the different corrections he gave us about the language, which were accepted and of course we will take into account the revision of a native speaker for the general correction of the language

It is evident throughout the article.

Reviewer Comment

Reviewer response

Modification (page and line number)

. Please add an explanation of previous research on pesticide poisoning in the introduction section as it is insufficient.

Thank you. In the introduction in the first and second paragraph, some research that has been done on pesticide poisoning in the agricultural sector is addressed, in addition to events that have occurred in Colombia.

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Section: Introduction

. The first result table shown in the Result section of every paper must show the sociodemographic characteristics of the survey participants. The relevant content here corresponds to Table 2 in your paper. Therefore, please present Table 2 as the first table of results.

Thank you. The sociodemographic description is moved to the results section

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Line number: 235 to 289

. Please show your reliability for the variables used in the analysis in the survey items.

Thank you. The instrument used was based on previous studies such as Oropesa et al. and Barrón Cuenca et al., who had similar objectives. The reliability of the instrument and the study variables was based on validation by community experts, in addition to taking into account that the instrument.

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Line number: 162 – 163 / 174 – 175

Dear Editor and Reviewers. We appreciate the time spent on article feedback. We have made each of the annotations, and reviewed the document with the university's language service, to attend to the comment on English.

Reviewer 4

Reviewer Comment

Reviewer response

Modification (page and line number)

 This paper describes a study carried out on agricultural workers in Colombia addressed at occupational pesticide poisonings. I think that the authors do not offer details regarding the phenomena in their Country. In particular: how many severe cases with hospitalization? How many mild? How many fatalities? From which compounds? As far as I know the pesticide market in the Country is changing, and most of the more critical compounds are being phasing out. Or am I wrong? In any case, some information on matter is strongly needed, in order to better understand the problem the Authors are dealing with.

Thank you. We have improved the introduction, to make it easier to understand the problem that the study solves.

Page: 1 and 2

Section: Introduction

A further point is that the Authors do not clarify the criteria adopted for the selection of the study population: I really cannot understand the whole paragraph after the phrase “We aimed to determine the number of agricultural workers of the area”. Why determining the number? Statistical data in the Country are not available? Why? And why not considering persons under the age of 20? I understand that the Authors want only adults, but the cut off ages between children, teenagers and young adults are different and universally accepted. For sure, persons aged more than 18 can be considered adults.

 Thank you. The section is rewritten mentioning that it was possible to survey 10% of the population that has been in contact with pesticides, taking into account that 1048 people live in the area, but of this total many are women dedicated to household activities and children who do not have contact with pesticides. Therefore, family members of farmers were not included.  The following paragraph Line 179-183 explains the type of population under study. 

Also, the approach carried out only with a questionnaire creates some doubts; I am unsure weather a questionnaire is the best tool for this kind of study, and for sure the most severe cases and the fatalities would be lost.

Thank you. The instrument used was based on previous studies such as Oropesa et al. and Barrón Cuenca et al., who had similar objectives. The reliability of the instrument and the study variables was based on validation by community experts, in addition to taking into account that the instrument.

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Line number: 162 – 163 / 174 – 175

The independents variables selected by the Author for the logistic regression (Work-shift; Facemask, Gloves, and Overall use; Hygiene habits such as Change of workwear and Body cleaning) are questionable. Variables such as training, type of pesticide used, machinery, modalities of application are not considered, so it seems that the Authors have selected some specific determinants of exposure among a big number of determinants, and this might create some bias.

Thank you.

We appreciate the reviewer's observation on the selection of independent variables in the logistic regression model. It is true that pesticide exposure can be determined by multiple factors, such as training, the type of pesticide, the machinery used and the application modalities. However, as described in the methodological section (section 2.2), the present study was designed using a structured questionnaire based on previously validated instruments [19,20], and its content was reviewed and adjusted in conjunction with local community leaders to ensure its relevance and feasibility in the rural context of Ciudad Bolívar.

Given the practical approach and the limited availability of technical information by rural workers, the inclusion of variables related to protection practices and hygiene habits (use of PPE, working hours, change of clothes and body cleaning) was prioritized, due to their direct relevance and observability as exposure control measures. Variables such as type of pesticide, machinery or application modalities, although important, could not be systematically recorded in this study due to limitations in the technical knowledge of the participants and the difficulty of standardizing these responses under the implemented survey design.

We recognize that this selection may have limited the inclusion of other determinants of exposure, which represents a potential source of bias. This limitation has now been pointed out in the discussion section of the manuscript, underscoring the need for future studies that include a broader approach to the technical factors of occupational exposure.

We add at the discussion:

One of the main limitations of this study concerns the selection of independent variables included in the logistic regression model. While multiple factors may influence pesticide exposure—such as the type of pesticide used, application methods, equipment involved, and prior training—this research prioritized variables that were both observable and directly related to workers’ routine practices in the field. Specifically, the analysis focused on personal protective equipment (PPE) use and hygiene habits, which are considered immediate determinants of exposure and are more easily assessed in rural settings with limited access to technical data and formal education. However, the exclusion of other potentially relevant factors may have limited the explanatory power of the model and introduced some degree of bias. Future studies should consider incorporating a broader range of exposure determinants, including detailed information on pesticide types, frequency of use, application techniques, and training history, to enhance the robustness of risk assessments.

Line 317 to 329

As for the “negative effects” reported, I think that collecting this data with a questionnaire can create significant bias, and some terms such as visual, respiratory, dermic, digestive and neurological conditions are too generic to be helpful, and in some cases the prevalence is impressive, reaching, for visual conditions, rates close to 50%. The interpretation of these data is very difficult: for example, why visual conditions? Which kind of effect do the Authors mean?

Thank you. We also appreciate the observation regarding the use of questionnaires to collect information on adverse health effects. As detailed in the methodological section (section 2.2), open-ended questions were included to identify health conditions with a possible occupational relationship and participants were asked to indicate whether they had received medical attention or had documentation to support the diagnosis. However, we recognize that as these are self-reports, recall biases and overestimation of symptoms may occur. Therefore, the high prevalence of some conditions, such as visual conditions (46%), should be interpreted with caution.

As for the category of "visual conditions", it is clarified that this refers mainly to symptoms such as blurred vision, eye irritation, and persistent redness after exposure, as reported in the open records of the questionnaire. However, we agree with the reviewer that these categories are general and that a more specific clinical characterization would strengthen interpretation. This limitation has been included in the discussion of the manuscript, indicating that the findings should be considered as indicative and not as confirmed clinical diagnoses, and highlighting the need for future research with clinical tools or biomarkers that allow an objective validation of the health effects. We also add the components used in the pesticides that circulate in Colombia and that helps to understand the increase in the reporting of symptoms.

We add at the discussion:

Another important consideration is that health outcomes were self-reported by participants, which may introduce recall or subjective interpretation bias. Although open-ended questions were used to allow detailed descriptions of symptoms, and participants were asked whether they had received medical attention for reported conditions, no clinical assessments were performed to confirm diagnoses. This may help explain the high prevalence of certain symptoms, such as visual impairments, which were reported by 46% of participants. According to respondents, these issues primarily included eye irritation, redness, and blurred vision following pesticide application. While such data are valuable in highlighting workers' perceived health impacts, they must be interpreted with caution. Future research would benefit from incorporating clinical evaluations or validated diagnostic tools to objectively verify the presence and severity of pesticide-related health effects.

Line 331-342

In conclusion: in the current version the paper is not well organized, it is difficult reading it also for a language problem, and the scientific component suffers several important limitations.

Thanks for the comment, we consider that we have thanks to the comments of the four reviewers, improved the quality and transparency of the manuscript.

Through the manuscript.

On the other hand, the Authors have collected a significant body of data which can be better elaborated and described to obtain an interesting and useful paper.

Thank you. We hope that the changes to the manuscript will make it clearer and more transparent about its findings.

Not applicable

Comments on the Quality of English Language

The language represents an important limitation of this pape. In this version, it is very hardly readable, and a revision by a mother tongue English speaker is recommended.

Thank you. We use the University's language service to review the quality of the English translation.

Through the manuscript.