Research of determination of health problems and utilization of health services in agricultural workers in the province of adana and proposition of health delivery model(S)

Background and Purpose: Among agricultural workers, especially in the seasonal-migratory ones; infectious diseases and parasites, housing and water hygiene related issues, work accidents and occupational diseases, low levels of education, poverty, absence of social security and problems in the access of health care system emerges as a significant public health problem. The purpose of this research is to identify socio-demographic characteristics, investigate health problems and access status to health services of agricultural workers in Adana and, to propose health service model(s) in accordance with the current health care system for agricultural workers in the light of findings obtained. Materials and Methods: This research, conducted on resident agircultural workers (RAW) and seasonal agricultural workers (SAW) aged 15-65 operating in the province of Adana is a descriptive study. In 2012 under Remediation Project of Labour and Social Life of Seasonal Migrant Agricultural Workers (RPSAW), infrastructure services and training was given to SAW in 53 regions across Adana. 50% of these regions were targeted to be achieved and a total of 28 regions were selected by simple random sampling method including, 2 from Ceyhan, 8 from Yüreğir, 7 from Seyhan, 8 from Karataş and 3 from Yumurtalık. For SAW, the sample should include 382 workers considering 54% incidence of health problems in the last one year based on "Needs Assessment Study on Seasonal Agricultural Workers and Their Families" in 2011 with 95% confidence interval and 5% error margin and according to the size of unknown universe; for RAW there was no previously conducted similar study thus the incidence of health problems in the last year was considered to be 50%; with 95% confidence interval and 5% error margin and according to the size of unknown universe, the sample should include 384 RAWs. Participants were administered a questionnaire developed by researcher, consisting of four sections and a total of 74 questions, querying participants' demographic characteristics, housing conditions, occupational and health status. Chi-square test, t-test and logistic regression tests were performed for statistical analysis and p-value <0,05 was considered to be significant. Evaluation was performed using SPSS 19.0 for Windows software. Results: The mean age of RAW was 38,9±13,6 and the mean age of SAW was 30,5±13,5; SAW shows a young population distribution, and the difference was significant (t=-8,703, p=0,0001). All SAW are living in tents largely made of tarp, canvas and reed. In our study, the average daily working hours of agricultural workers is 10,4±2,2. 86,5% of respondents' monthly income is below 1000 TL. 60% of agricultural workers became ill in the past year and accordingly 76,2% of the agricultural workers have visited physician. It was determined that 54% of RAW applied to the family physician in the last year of whereas 40,5% of SAW and the difference was significant in favor of RAW (χ2 = 14,572, p = 0,0001). In our research the ratio of participants visited at home by the health personnel over the past one year is 15,4%. In our study, the probability of having a background disease history in female agricultural workers was 2,43 times; having a disease within the past one year was 1,87 times than male workers. Agricultural workers who do not receive vocational training, the probability of having a background disease history was 2,02 times; having a disease within the past one year was 1,97 times than those who received training. Agricultural workers engaged pesticide in the field was 1,66 times likely to get sick within the past one year than those who do not. Conclusion : In our study, agricultural workers especially SAWs were found to be living in poor housing conditions, having low incomes, working for long hours. In our study, women, those who did not have receive vocational training and those engaged in spraying in the field were determined to be more likely to get sick. It is identified that agricultural workers who fall ill are unable to benefit sufficiently from primary and mobile health services. It is necessary to raise the level of health in agricultural workers with regular-continuous mobile health care services which also include health education/counseling. To render these services effective, the elimination of shelter, nutrition, education, social security and economic issues is a prerequisite.