Interventions for preventing injuries in the agricultural industry

Background Agriculture is more hazardous than most other industries. Many strategies have been introduced to reduce injuries in the field, yet the effectiveness of different interventions on occupational injuries still remains unclear. Objectives This review aims to determine the effectiveness of interventions to prevent occupational injuries among workers in the agricultural industry compared to no interventions or to alternative interventions. Search methods Cochrane Central Register of Controlled Trials, Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, PsychINFO, OSH‐ROM (including NIOSHTIC and HSELINE) databases were searched up to June 2006. Reference lists of selected articles, relevant reviews and additional topic related databases and web sites were also searched. The searches were not restricted by language or publication status. Selection criteria Randomised controlled trials, cluster‐randomised controlled trials, prospective cohort studies with a concurrent control group, and interrupted time series studies assessing any type of intervention aiming to prevent fatal or non‐fatal injuries among workers in agriculture. Data collection and analysis Two reviewers conducted data extraction and study quality assessment independently. Rate ratios of randomised controlled trials were calculated and the effect sizes were combined in a meta‐analysis. Interrupted time series studies were reanalysed and each of them studied for having an immediate and a progressive effect. Main results Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria. For educational interventions aiming at reducing injury rates among adults the pooled rate ratio after recalculation from effect sizes in three RCTs was 1.02 (95% CI 0.87 to 1.20). For educational interventions aiming at children the pooled rate ratio for injury rates in two RCTs was 1.27 (95% CI 0.51 to 3.16). One ITS study that evaluated the effect of an intervention that included financial incentives decreased the injury level immediately after the intervention with an effect size of ‐2.68 (95% CI ‐3.80 to ‐1.56) but did not have a significant effect on the injury trend over time with an effect size of ‐0.22 (95% CI ‐0.47 to 0.03). One ITS study that evaluated the effect of legislation to ban Endosulfan pesticide on fatal pesticide poisonings increased the level of poisonings immediately