Work accidents with children and youth in a rural environment in southern Brazil

Objective: to know the prevalence of occupational accidents in children and youth who work with their families in the rural environment and to identify the associated factors. Method: exploratory, descriptive and analytical study with quantitative approach, developed in three rural areas. Participants were 211 children and young people who assisted the family in rural work. Data collection was performed using a semi-structured questionnaire. Bivariate analysis was performed using Pearson’s chi-square, Fisher’s exact, Student’s t and Mann-Whitney tests and multivariate analysis using Poisson regression. Results: the prevalence of self-reported occupational accidents was 55%. It was highlighted: insect bites (44%), burns (40.5%), falls (27.6%), injury with a working tool (16.4%), electric shock (15.5 %), burn by animal (8.6%), animal bite (6.9%) and pesticide poisoning (2.6%). These were related to shared housing, leisure activity - riding a motorcycle, product resulting from lettuce cultivation and use of personal protective equipment. Conclusion: it is believed that these findings may enhance the development of public policies aimed at preserving the health of these children and young people, regulate working conditions and reduce occupational risks in the rural environment.


Introduction
Individuals living in rural environment are exposed to socioeconomic vulnerabilities that force them to develop subsistence work activities from an early age. Often, these activities are carried out within the family and involve the help of children and youth (1) .
In this context, they generally work in subsistence agriculture, fisheries and cattle, performing tasks such as soil preparation, crop planting, harvesting, loading of products, preparation of fishing nets and the raising of cattle, horses and sheep (2) . It is noteworthy that the inclusion of these children and youth in rural work can be positive for their civic development, as well as for the family economy if it does not, negatively, affect health and/or education (3) .
In carrying out their activities to help relatives in rural work, children and young people often use and/or are exposed to rivers, deep seas and lakes, animals, chemicals, dangerous machinery and tools, heavy lifting and transportation of products through automotive vehicles such as tractors and trucks. In addition, there are the long periods of time in these tasks, which require attention and muscle strength, fast pace of production, staying in awkward body positions and the different weather conditions they face, such as extreme temperatures and storms that put them at risk of accidents during work (2,(4)(5) .
National and international evidence points that accidents in rural work, especially in the agriculture and fisheries subcategories, represent a major cause of accidents and mortality in children and young people of both sexes, aged 10 to 24 years (6) . Drowning, traffic accidents, burns, falls, contusion, fractures, transfixing injuries and crushing as common events resulting from inattention during work due to physical and mental exhaustion, caused by complex and dangerous tasks, are highlighted in this age group (1,4,(6)(7)(8) .
Although the inclusion of children and young people in agricultural, fishing and cattle raising activities in rural family communities is advantageous from the subsistence point of view, it can represent an obstacle to their biopsychosocial development. Still, it can be detrimental to the health and safety of these individuals, since they are often unaware of the risks to which they are exposed and assume activities beyond their physical and mental capacities, which favors the occurrence of occupational accidents (1)(2) .
In this perspective, alternatives are needed to take these children and young people off from the vulnerability and risks which they are at. International literature emphasizes that public policy investment aimed at accessing education in rural communities has the potential to generate economic benefits for these individuals and to public finances. Moreover, quality education can stop the vicious cycle of poverty, typical of the rural economy (2) .
In addition, children and young people living and working in rural areas need to be a priority in health actions. Nurses are professionals who work directly with individuals in the context of collective health, predominantly in primary health care. In this sense, their cooperation with the provision of care to children and young people exposed to the risks of work in their productive processes is essential, along with the production of scientific and empirical knowledge that grounds public policies, focusing on protection, surveillance, health promotion and disease prevention to this public. Thus, investigating the health-work process relationship, in the focus of occupational accidents in rural environments, represents an important contribution in the area of collective health and occupational nursing.

Method
This is an exploratory, descriptive and analytical study with a quantitative approach. It was developed in three rural environments in southern Brazil.
The participants were 211 children and young people exposed to risks and accidents at work in these places, during the study period.
Due to the lack of records of the total number of children and young workers in rural areas in official sources, state and municipal agencies made an estimate based on the percentage of the population, according to age groups (10-14 which is equivalent to 4.4%, 15-17 equivalent to 4.5% and 18-24 equivalent to 4.5%), according to the distribution described in the Brazilian Institute of Geography and Statistics (9) . Based on this criterion, these percentages of the general population were applied to the total inhabitants of each rural environment, that is, the first (1,800 inhabitants), the second (1,200 inhabitants)     The damage would occur anyway 1 (1.

Discussion
The results showed that of the 211 respondents (children and youth), 116 (55%) were affected by accidents assisting their families in rural work.
Accordingly, a study conducted in Canada (13) identified a high incidence of occupational accidents in this same population, with annual rates of 15.8%. A larger proportion of these events were reported in low-income countries, as found studies such as Indian (14) , Chinese (15) , and Iranian (16) . These results reinforce occupational accidents, in this age group, as a public health problem because they indicate grievances that require interventions, in order to enable the improvement of quality of life in developed and developing countries.
In the Indian (14) , Iranian (16) , and Chinese (17) studies, evidence of work-related injuries in children and young people assisting the family in rural work, animal events such as dog bites and insect bites , followed by falls and burns were found. These findings corroborate what was found in the present study and confirm the importance of identifying and acting on its causes.
In the case of this investigation, the occurrence of occupational accidents was associated with lack of attention at work (93.7%), which converged with the results of the North American research (18) . In this, it was found that children and young people who helped in agricultural work, over time, had reduced attention to activities they performed, favoring the occurrence of occupational accidents. Furthermore, it was pointed the need for training for them and their families on the risks to which they are exposed to, use of PPE, minimization of risk factors for health and well-being in the work environment and family monitoring while performing their activities.
Although this study did not identify the presence or absence of the relative at the time of the accident, other research found that two thirds of children killed in agricultural accidents were supervised by a relative and that in half of these events, the relative was close to them or provided to them exact instructions and information prior to the incident. Thus, it was found that family members often overestimate the skills of children who sometimes perform dangerous tasks, such as driving tractors and motor vehicles, fishing and caring for animals -horses, cows and others -which favors accidents (18)(19) . Findings from the present study and those included in the argued dialogue reinforce the magnitude of a set of organized actions to meet the needs of the families of these children and youth. As a strategy, it is emphasized the need for training on risks and their management, which increases the ability to assess the existing hazard and the decision to avoid it.
It was also found that the most frequent occupational accidents in young people occurred at the age of 15 and among females (118; 55.9%). Although these variables are not statistically significant, they may constitute a risk factor for these circumstances. Despite the participants of this study, with a minimum sample representative of the population, it is understood that, even incited and informed about what is an accident, did not sufficiently understand what is an occupational accident. Accordingly, an Indian finding (19) verified that occupational accidents in children and youth in the rural environment occurred more frequently between 6 and 15 years of age, but with a predominance of males.
However, in another study (13) there were high rates of these accidents in the age group of 10 years or less, North Carolina (18) , Brazil (20) , Nepal (21) , and Canada (22) confirmed this finding by verifying that children and young people who assisted in agriculture generally had incomplete primary education due to the prioritization work and financial difficulties. On the other hand, the low educational level of the participants may be related to the fact that they assist family members in rural work for a long timeframe and in the opposite shift from school attendance, which can cause fatigue and consequent dropout.
Regarding the daily working hours, this study showed that children and young people who worked with family members for long hours were at higher risk for accidents. A similar finding in a survey in Peru (23) was verified, whose data revealed that of the 375 children and young people who assisted in rural work, 363 (97%) had www.eerp.usp.br/rlae 8 Rev. Latino-Am. Enfermagem 2020;28:e3243.
already suffered some type of occupational accident and that 188 (51,2%) worked more than eight hours a day.
Prolonged hours lead to physical and mental exhaustion which, in addition to contributing to occupational accidents, make these individuals use their free time to rest and replenish their energy to continue the work the next day, having shorter time for recreational activities.
It was found that the participants had reduced time for leisure, which contributes to personal dissatisfaction, demotivation, decreased quality of life and, consequently, the occurrence of work accidents.
In this sense, the literature points that young people who work in the rural environment spend many hours in their workplace and, because of this, feel overloaded and too tired for recreational activities, intensifying occupational injuries (24) . However, in a Chinese study, it was evidenced that individuals who can balance work and leisure hours self-report better vital energy indexes, motivation for daily activities, improved cognitive and emotional functions to manage stress and decrease the incidence of occupational accidents, compared to those who have no recreation or have little time for entertainment (25) .
It was also found that the participants who worked in fishing for fish and/or shrimp had a higher risk for occupational accidents. Similar data were checked in surveys conducted in Alaska (26) and Canada (27) , in which children and young people who have fishing as work activity are subject to injury from sunburn and the handling of work tools such as knives and hooks and ciguatera (food poisoning). These evidences infer that the interaction between work and accidents and/or illnesses should not be neglected when planning health interventions with this public.
In addition, in the present study, the type of mixed housing showed a 29% higher probability of occupational accidents. In a study conducted in China (17) , it was Another relevant aspect evidenced by this study was the fact that children and young people who used motorcycles presented a 69% increase in the prevalence of occupational accidents. Its use as means of transportation by the participants is justified because it promotes easy mobility in the rural work environment due to the long distances traveled. A Canadian study (13) showed that the use auto motors as work tools, such as tractors, pickup trucks, trucks and motorcycles, although facilitating the transportation of objects and loads in rural areas, doubled the incidence of accidents in children and young workers.
On the other hand, those who had leisure activities, such as listening to music, had a 51% reduction in the prevalence of occupational accidents. In this sense, the literature has revealed that recreational activities such as walking, cycling, yoga, music, meditation and participation in social groups, as well as school activities, impact the quality of life of children and young people and, as an effect, their ability to work (28) .
Therefore, it is relevant to emphasize the need to keep a balance between work, recreation and school, due to the increase of technical-scientific knowledge about prevention and expansion of the ability to focus attention on work activities.
In the case of the present study, among the set of products resulting from the work activity of children and young people, only the activity related to lettuce crop presented the highest probability (86%) of occupational accidents. In this sense, the literature points that agricultural accidents, regardless of the product of the activity, were mainly related to the use of pesticides/ agrochemicals (29)(30) . Although this study did not address issues related to the use of pesticides, other research conducted in China found that the use of these products on crops, such as lettuce crops, associated with the use of sharp instruments such as knives, machetes and sickles, can cause, among other effects, the reduction of muscle strength and marching instability, which favors accidents related to cuts, falls and fractures (27) .
It is also noteworthy that the participants who inappropriately or incompletely, compared to students with more education (24) . This are findings that may

Conclusion
In the present study it was found that the prevalence of occupational accidents such as insect bites, burns and falls in the workplace, in children and young people who worked with their families in the rural environment was expressive and was related to the type housing, leisure activities such as riding a motorcycle, product resulting from work activity, such as lettuce cultivation and use of PPE. On the contrary, it was evidenced that leisure activities such as listening to music and the addition of one year of schooling contribute to the reduction of work accidents.
It is believed that these findings may increase the development of social policies aimed at preserving the health of this public, controlling working conditions and reducing occupational risks in the rural environment.
In addition, the identification of the most prevalent