Introduction Pesticide use is increasing in developing countries trying to boost their agricultural production. Due to lack of proper knowledge among small-holder farmers this leads to frequent poisonings of farmers and pollution of the environment. Integrated Pest Management (IPM) has been tried out to minimise the use of pesticides and a banning of the most toxic pesticides is seen in some countries.

Methods Small-holder farmers from Bolivia, Nepal, Uganda and Cambodia were interviewed in cross-sectional baseline studies before an intervention teaching farmers IPM took place. Follow-up studies were conducted after training was completed to evaluate the effect of the trainings. Sound statistical methods were applied while controlling for relevant confounders. Ethical approval was obtained.

Results At baseline farmers used generally very toxic pesticides, most pronounced in Bolivia. Farmers had little knowledge and use of personal protection when handling pesticides, and use of alternatives to pesticides were scarce. Pesticide poisonings were commonly reported and an effect with a lowered blood level of AChE was seen depending on spraying frequency, use of PPE and the toxicity of the pesticides used. Training improved farmer’s knowledge and practice on pesticide handling and IPM and lowered the number of symptoms of poisoning after spraying. Obstacles for a wider diffusion of IPM seem to be an extra workload not always compensated for by higher prices of the products.

Conclusion Pesticide poisonings is increasing among farmers from low income countries, leading to acute symptoms eventually dead or chronic poisonings with neurological impairment, cancer, lung diseases or skin diseases and fetal damage. Pesticide abuse can be prevented without the loos of crops by teaching farmers integrated pest management methods and political interventions with a ban of the most dangerous pesticides nationally and worldwide have proved effective as well.