Sugarcane cutting work, risks, and health effects: a literature review

Leite, Marceli Rocha; Zanetta, Dirce Maria Trevisan; Trevisan, Iara Buriola; Burdmann, Emmanuel de Almeida; Santos, Ubiratan de Paula

doi:10.11606/S1518-8787.2018052000138

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Review • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052000138 linkcopy

Sugarcane cutting work, risks, and health effects: a literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE Describe the main work risks for sugarcane cutters and their effects on workers’ health.

METHODS Critical review of articles, with bibliographic research carried out in the PubMed, SciELO Medline, and Lilacs databases. The following keywords were used: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açú car , and colheita de cana -de-açúcar . The inclusion criteria were articles published between January 1997 and June 2017, which evaluated working conditions and health effects on sugarcane cutters. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter’s health were excluded. The final group of manuscripts was selected by the lead author of this study and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author.

RESULTS From the 89 articles found, 52 met the selection criteria and were evaluated. Studies have shown that cutters work under conditions of physical and mental overload, thermal overload, exposure to pollutants, and are subject to accidents. The main effects observed were respiratory, cardiovascular, renal, musculoskeletal, heat stress, dehydration, genotoxic, and those due to accidents.

CONCLUSIONS Work on the manual cutting of sugarcane, especially of burned sugarcane, exposes workers to various risks, with different health impacts. Risk reduction for exposure to pollution and thermal and physical overload is required as a measure to preserve the health of the worker.

Rural Workers; Health Status; Working Conditions; Occupational Risks; Occupational Health; Review

Topics covered	Authors	Number of articles
Mucociliary clearance	Ferreira-Ceccato et al. ²⁰ ; Goto et al. ¹⁹	2
Respiratory symptoms	Prado et al. ¹⁸ ; Ferreira-Ceccato et al. ²⁰	2
Pulmonary function	Prado et al. ¹⁸ ; Goto et al. ¹⁹	2
Inflammatory markers and oxidative stress	Prado et al. ¹⁸ ; Barbosa et al. ¹⁴ ; Santos et al. ³¹	3
Pulmonary disease	Sacchi et al. ⁷⁹	1
Cardiovascular effects	Barbosa et al. ¹⁴ ; Vilela et al. ¹³	2
Renal effects	Garcia-Trabanino et al. ⁴⁵ ; Laws et al. ⁵⁸ ; Laws et al. ⁵⁹ ; López-Marin et al. ⁶⁰ ; Murray et al. ¹² ; Peraza et al. ⁴¹ ; Roncal-Jimenez et al. ⁶¹ ; Santos et al. ³¹ ; Wesseling et al. ⁶² ; Wesseling et al. ¹¹ ; Wesseling et al. ⁶³ ; Wijkström et al. ⁴⁶	12
Miscellaneous infections (toxoplasmosis, leptospirosis, and brucellosis)	Adesiyun et al. ⁶⁴	1
Quality of life assessment	Carvalho-Junior et al. ⁶⁵	1
Stress, physical and mental symptoms	Priuli et al. ⁶⁶	1
Frequency of sick leave due to occupational diseases	Ferreira-Ceccato et al. ⁶⁷	1
Ergonomic assessment of the work	Abrahão et al. ¹⁶	1
Occurrence of fungi in the ocular conjunctiva	Dalfré et al. ⁶⁸	1
Risk of lung and oral cavity cancer	Amre et al. ⁶⁹ ; Coble et al. ⁷⁰	2
Exposure to potentially carcinogenic agents and genotoxic effects	Prado et al. ¹⁸ ; Bosso et al. ⁴⁷ ; Martinez-Vanezuela et al. ⁴⁸ ; Silveira et al. ⁷¹	4
Work process on the health of sugarcane cutters	Alessi et al. ⁵⁵ ; Alves ¹⁷ ; Galiano et al. ⁷² ; Moraes et al. ⁷³ ; Ribeiro ⁸ ; Rocha et al. ⁵⁷ ; Rocha et al. ⁹ ; Rosa e Navarro. ⁷⁴ ; Scopinho et al. ⁷⁵ ; Vilela et al. ¹³ ; Bitencourt et al. ⁴⁹	11
Musculoskeletal disorders	de Anchieta Messias et al. ⁵⁶ ; Phajan et al. ³⁷	2
Thermal overload	Bodin et al. ⁵⁰ ; Crowe et al. ³⁸ ; Crowe et al. ¹⁵ ; Crowen et al. ¹⁰; Roscani et al. ⁵¹ ; Vilela et al. ¹³	6
Body composition/hydration and nutritional status	Cortez et al. ⁵² ; Chiarello et al. ⁵³ ; Florêncio et al. ⁷⁶ ; Luz et al. ⁷⁷ ; Luz et al. ⁵⁴	5
Dermatological changes	Miranda et al. ⁷⁸	1

Authors/Study	Study	Results
Ferreira-Ceccato et al. ²⁰ (2011) Panel study, with repeated measurements.	Nasal mucociliary clearance in 45 sugarcane cutters State de São Paulo, Brazil	Reduction of the transit time of saccharin, on the first day of harvest compared to the pre-harvest period.
Goto et al. ¹⁹ (2011) Panel study, repeated measurements	Nasal mucociliary clearance of 27 sugarcane cutters State de São Paulo, Brazil	Increased in the transit time of nasal mucus after six months of harvest.
Prado et al. ¹⁸ (2012) Panel study, repeated measurements	Respiratory symptoms, lung function, markers of oxidative stress, and exposure to aromatic hydrocarbons in 113 cutters of burnt sugarcane State de São Paulo, Brazil	Higher incidence of respiratory symptoms, decreased pulmonary function, oxidative stress, increase of 1-hydroxypyrene (1-OH) during the harvest, compared to the pre-harvest period.
Sacchi et al. ⁷⁹ (2013) Case-control study	Risk factors for pulmonary and extrapulmonary tuberculosis among indigenous peoples in Brazil	Indigenous workers in sugarcane plants are 6.8 times more likely to have tuberculosis.
Barbosa et al. ¹⁴ (2012) Panel study, repeated measurements	Effects of burned cane harvest on blood markers and cardiovascular system in 28 sugarcane cutters State de São Paulo, Brazil	Increase in blood pressure and blood coagulability during the harvest period compared to the pre-harvest period.
Garcia-Trabanino et al. ⁴⁵ (2015) Cross-sectional study	Thermal stress, dehydration, biomarkers of renal function and their possible associations in 189 sugarcane cutters of El Salvador	The average temperature of the working day was 34 °C-36 °C before noon and 39 °C-42 °C at noon. There was a reduction in the glomerular filtration rate in 14% of the workers, and an increase in serum creatinine, uric acid, and urea.
Laws et al. ⁵⁸ (2015) Longitudinal study	Changes in renal function over six months of sugarcane harvest in 284 Nicaraguan workers	Decreased renal function during the harvest.
Laws et al. ⁵⁹ (2016) Prospective cohort study.	Changes in renal injury markers of 284 Nicaraguan rural workers	Of the seven categories of workers studied, sugarcane cutters presented a higher risk of renal damage.
López-Marin et al. ⁶⁰ (2014) Cross-sectional study	Histopathological characterization of chronic kidney disease (CKD) in patients from agricultural communities, including sugarcane cutters El Salvador	Presence of chronic tubulointerstitial nephropathy with glomerular and secondary vascular injury.
Murray et al. ¹² (2015) Review study	Evaluation of potential pathogens responsible for Mesoamerican nephropathy in Nicaragua	Infectious pathogens present in urine and rodent feces are thought to expose workers during the cultivation and harvesting of cane and are associated with CKD.
Peraza et al. ⁴¹ (2012) Cross-sectional study	Prevalence of decreased renal function in men and women (farmers) in five communities in El Salvador	Agricultural work on sugarcane and cotton plantations was associated with decreased renal function.
Roncal-Jimenez et al. ⁶¹ (2015) Cross-sectional study	Increased uric acid concentrations as a possible cause of kidney damage. Review and pilot study evaluating 10 sugarcane cutters in El Salvador	Serum levels of uric acid increased after a work shift and reached hyperuricemia (≥ 7.0 mg/dL).
Santos et al. ³¹ (2014) Longitudinal panel study with repeated measurements	Effect of work cutting burned sugar cane on the renal function of 28 workers State de São Paulo, Brazil	Decreased glomerular filtration rate at the end of the work shift, in all evaluated patients, and, in 18.5% of them, the increase in serum creatinine was consistent with acute kidney injury (AKI).
Wesseling et al. ⁶² (2015) Review study	Risk assessment of CKD mortality in rural workers Costa Rica	Mortality due to CKD in men was higher in areas with hot and dry climate, lower altitude, and extensive production of sugarcane.
Wesseling et al. ¹¹ (2016) Longitudinal panel study with repeated measurements	Evaluation of renal function markers in 29 sugarcane cutters Nicaragua	A 9% decrease in the glomerular filtration rate, increased creatinine and serum urea and NGAL after 2 months of work.
Wesseling et al. ⁶³ (2016) Cross-sectional study	Evaluation of risk factors for CKD among sugarcane cutters, construction workers, and small farmers Nicaragua	Thermal stress, dehydration, and kidney failure were the most common findings among sugarcane cutters and increased uric acid was associated with reduced renal function.
Wijkström et al. ⁴⁶ (2017) Case series	Renal histopathological evaluation of 19 sugarcane workers Nicaragua	16 renal biopsies presented glomerulosclerosis, glomerular hypertrophy, chronic glomerular ischemia, tubulointerstitial damage, and mild vascular alterations.
Adesiyun et al. ⁶⁴ (2010) Cross-sectional study	Prevalence of toxoplasmosis, leptospirosis, and brucellosis in sugarcane workers on the island of Trinidad	High risk of acute toxoplasmosis and, to a lesser extent, leptospirosis.
Carvalho-Junior et al. ⁶⁵ (2012) Longitudinal study	Health-related quality of life assessment of 44 sugarcane cutters from the West of the State of São Paulo, Brazil	Quality of life, measured by questionnaire, was reduced at the end of the harvest period.
Priuli et al. ⁶⁶ (2014) Longitudinal study	Stress levels and prevalence of physical and mental symptoms in 114 sugarcane workers State de São Paulo, Brazil	The work process of the cane cutter can cause stress, symptoms of burn out, exhaustion, physical and psychological symptoms after the harvest period.
Ferreira-Ceccato et al. ⁶⁷ (2014) Cross-sectional retrospective descriptive study	Frequency of sick leave due to occupational diseases by sugarcane cutters State de São Paulo, Brazil	Musculoskeletal diseases followed by respiratory diseases at the end of the harvest were more prevalent.
Abrahão et al. ¹⁶ (2012) Cross-sectional study	To evaluate the impact of glove use on the safety, efficacy, and comfort of 82 sugarcane cutters State de São Paulo, Brazil	Results reveal general inadequacy of gloves used due to lack of adhesion to the machete, inadequacy in size, and hardening of the glove by contact with sucrose and ashes present in sugarcane.
Dalfré et al. ⁶⁸ (2007) Cross-sectional study	Occurrence of fungi in the ocular conjunctiva of 100 sugarcane cutters Minas Gerais, Brazil	Of the 100 workers evaluated, 64 presented one or more genera of fungi, with higher incidence in the more advanced age groups.
Amre et al. ⁶⁹ (1999) Case-control study	Investigate the risk of lung cancer among sugarcane producers Maharashtra, India	Risk of lung cancer doubled in workers on sugarcane farms.
Coble et al. ⁷⁰ (2003) Case-control study	The relationship between occupational exposures and oral cavity or pharynx cancer (n = 367) Puerto Rico	High cancer risks were observed among sugarcane producers and in individuals with high cumulative exposure to solvents.
Bosso et al. ⁴⁷ (2006) Longitudinal study	To evaluate the concentrations of 1-hydroxypyrene in the urine of 39 sugarcane workers State de São Paulo, Brazil	The level of 1-OHP in urine was 9 times higher in exposed workers compared to those not exposed.
Martinez-Vanezuela et al. ⁴⁸ (2015) Cross-sectional study	To determine the chromosomal damage in oral mucosa in workers exposed to burnt sugarcane in Mexico (n = 60) compared to non-exposed workers (n = 60)	Higher presence of chromosomal micronuclei in oral mucosa and nuclear abnormalities in exposed workers, compared to non-exposed individuals.
Silveira et al. ⁷¹ (2013) Cross-sectional study	Genotoxic effect on burned sugarcane cutters (n = 23), compared to the control population (n = 30) Barretos, SP, Brazil	The frequencies of micronuclei in the cells of the mouth and blood were higher in sugarcane cutters.
Alessi et al. ⁵⁵ (1997) Qualitative study	Assessment of the work process in sugarcane cutter’s health in Ribeirão Preto, SP, Brazil	Daily exposure of cane cutters to physical, chemical, and biological loads, translates into several diseases, traumas, or accidents related to them.
Alves ¹⁷ (2006) Review study	To analyze the processes of production and working day in the manual cutting of sugarcane State de São Paulo, Brazil	Cane cutters’ deaths related to overwork and payment per production.
Anchieta Messias et al. ⁵⁶ (2012) Cross-sectional exploratory study	Evaluation of the posture in the work of a group of sugarcane cutters Pontal do Paranapanema, SP, Brazil	The movements and postures adopted during the work can predispose the cutters to repetitive strain injuries.
Galiano et al. ⁷² (2012) Qualitative study	Evaluation of the reasons of young people seeking work as sugarcane cutters and how they perceived their working conditions and health repercussions (n = 14) Ribeirão Preto, SP, Brazil	The data suggest that the migration of young workers in search of work was not an option, but the only alternative to the reality in their region of origin. They have expressed hopelessness about their prospects and concern about the possible consequences for their health.
Moraes et al. ⁷³ (2013) Cross-sectional study	To characterize the socioeconomic profile, the motivation, the perception of the impacts of the work on health, and the relationship with the health system of migrants who cut sugarcane Mendonça, SP, Brazil	The majority of the workers (90%) came from the Northeast region of Brazil; were between 18 and 30 years old; 86% considered the salary and formal employment the motivators for this type of work; 92% considered their health good, although 48% felt some type of body pain attributed to work fatigue, and 87% self-medicates.
Phajan et al. ³⁷ (2014) Cross-sectional analytical study	Prevalence and factors associated with work-related musculoskeletal disorders among 540 sugarcane workers Thailand	The prevalence of musculoskeletal disorders in the 7 days before the interview was 83%. The associated factors were: repetitive movements, inadequate postures, and vigorous efforts.
Ribeiro ⁸ (2010) Qualitative descriptive study	To portray the situation in which rural workers live in Macatuba, SP, observing their economic and social conditions, in the context of the implementation of the law that prohibits the burning of sugarcane and the mechanization of cutting, which bring an end to this type of employment (n = 40)	We evaluated 27 men and 13 women who received wages according to productivity. Part of them agreed with the ban to burnings because it eliminates much of the pollution they breathe, improving their quality of life.
Rocha et al. ⁵⁷ (2007) Qualitative descriptive study	Assessment of individual, social, labor, and environmental factors predisposing to illness in 39 sugarcane cutters State de São Paulo, Brazil	The main individual determinants of illness were physical exertion and accelerated work rate, intense heat, dust, soot, and presence of venomous animals. Poverty is the main social determinant of illness.
Rocha et al. ⁹ (2010) Exploratory study with a quantitative approach	To analyze the work and life situations that may offer health risks to 39 workers involved in the manual and mechanized cutting of sugarcane State de São Paulo/Brazil	During work, workers are exposed to long daily shifts and work environments with multiple health hazards, and respiratory, musculoskeletal, psychological, and accidental impacts.
Rosa e Navarro. ⁷⁴ (2014) Qualitative descriptive study	A total of 13 sugarcane cutter migrants were evaluated to understand the profile of the workers and to investigate their working conditions Ribeirão Preto, SP, Brazil	The workers are hired according to their capacity of production, physical resistance, and disposition of subordination to superiors. The production gain implies overexploitation of the labor force, which has repercussions on health conditions.
Scopinho et al. ⁷⁵ (1999) Qualitative descriptive study	Evaluation by interviews conducted in the field, the consequences of mechanized cutting of sugarcane State de São Paulo, Brazil	The use of mechanical harvesters reduces physical, chemical, and mechanical labor loads, but accentuates mental and physiological loads. Observed reduction in the number of accidents at work, but increased severity.
Vilela et al. ¹³ (2015) Longitudinal study	Study of determinants that intensify the workload and affect the health of 40 sugarcane cutters Piracicaba, SP, Brazil	The accelerated pace of work associated with payment per production is the main factor responsible for the increase in the physical exhaustion among workers.
Bitencourt et al. ⁴⁹ (2012) Case study	Contribution of the climate to the occurrence of 14 deaths of sugarcane cutters State of São Paulo, Brazil	The precarious social, economic, and working conditions of these workers do not allow us to point out the atmospheric factor as the predominant cause of the deaths.
Bodin et al. ⁵⁰ (2016) Longitudinal study with repeated measures	To assess the feasibility of providing an intervention (adequate water replacement and programmed rest periods) during sugarcane cutting to avoid heat stress and dehydration without decreasing productivity (n = 60) El Salvador	Post-intervention water consumption increased by 25%. The symptoms associated with thermal stress and dehydration decreased. Daily individual production increased from 5.1 to 7.3 tons/person/day.
Crowe et al. ³⁸ (2010) Observational and exploratory study	Conditions of heat stress in 130 sugarcane workers in Costa Rica in the pre-harvest period.	Risk of thermal stress for workers in pre-harvest tasks, which occurs even during periods of less intensive work.
Crowe et al. ¹⁵ (2013) Cross-sectional study	To describe the working conditions and quantify the heat exposure by sugarcane cutters (n = 105) Costa Rica	Cane cutters perform strenuous work under high temperatures, with no recommended breaks.
Crowe et al. ¹⁰ (2015) Cross-sectional study	Prevalence of complaints of heat exposure and health effects by 106 sugarcane cutters compared to 63 controls, workers in other activities Costa Rica	Symptoms of heat and dehydration (headache, tachycardia, cramps, fever, nausea, dizziness), hand or foot edema, and dysuria were more frequent in cane cutters than controls.
Roscani et al. ⁵¹ (2017) Cross-sectional study	Estimates of thermal overload in sugarcane cutters over a period of four years State de São Paulo, Brazil	The estimated IBUTG values exceed the limits of tolerance in the areas of sugarcane activity.
Miranda et al. ⁷⁸ (2012) Cross-sectional study	Prevalence of actinic cheilitis in 1,950 sugarcane cutters exposed to the sun, compared to the control group (n = 150)	The prevalence of 9.2% (n = 141) of actinic cheilitis was observed among the population that had been exposed to the sun. However, no cases were found among the individuals in the control group.
Cortez et al. ⁵² (2009) Longitudinal study with repeated measures	Evaluation of the effect of hydration on the increase of labor productivity in workers exposed to high temperatures (n = 22) Nicaragua	Workers with higher water consumption increased production from 5.5 to 8 tons/day of cut cane.
Chiarello et al. ⁵³ (2006) Longitudinal study with repeated measures	Impact of the use of protein and electrolyte supplements on weight and body composition of 15 sugarcane cutters Serrana, SP, Brazil	Observed reductions in body fat percentage and improvement in hydration at the end of the sugarcane harvest and 8 months after the beginning of the diet.
Florêncio et al. ⁷⁶ (2008) Cross-sectional study	Evaluation of dietary pattern, nutritional status, and stature of 62 sugarcane cutters and possible associations with worker productivity Alagoas, Brazil	Workers with normal BMI were the most productive compared to those with low or overweight BMI. Taller individuals had higher productivity and higher energy intake.
Luz et al. ⁷⁷ (2012) Longitudinal study with repeated measures	Evaluation of the evolution of the body composition of 30 cane cutters between the beginning and the end of the harvest Piracicaba, SP, Brazil	Significant loss of body fat and weight in the first half of the crop and elevation of creatine kinase over the harvest period.
Luz et al. ⁵⁴ (2014) Semi-quantitative observational study	Description of working conditions, feeding, and hydration of 30 sugar cane cutters, under observation for 15 days Piracicaba, SP, Brazil	Workers drink 5 to 10 liters of water per day. Feeding during the harvest did not guarantee food and nutritional security. Work on manual cane harvesting is strenuous and payment per production can be an aggravating health factor.

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[TFN1] IBUTG: Wet-bulb temperature-Globe Thermometer