Patterns of pesticide use and potential health risks among men and women farmers in Rwanda: Practices, behaviors, and knowledge in Eastern Province.

Rapid increases in pesticide use among smallholder farmers in Rwanda raise concerns about associated health impacts in human, animal and environmental systems. Women farmers warrant particular attention due to their substantial participation in agricultural labor and potential for distinct exposure patterns and health risks. We aimed to characterize pesticide use practices, safety knowledge, health effects and health concerns among Rwandan smallholder farmers using a gender-balanced, One Health-informed survey, which we administered to 109 male and 90 female smallholder farmers across 10 sectors of Rwanda's Eastern Province. Based on these self-reported data, we found pesticide use to be widespread and increasing, with more than 80% of participants reporting increased use within the past five years. The most used products were profenofos + cypermethrin insecticidal formulations and mancozeb-based fungicides, with 95% and 83% of participants reporting often or sometimes using these products, respectively. Self-reported symptoms potentially consistent with acute pesticides poisoning were also common, with 89% of participants reporting experiencing eye irritation, 83% rash, 73% headache and 67% breathing problems following pesticide use. Pesticide-related knowledge, concern, and safety behaviors were largely similar between men and women, including high levels of concern about health risks. Rwandan smallholder farmers increasingly rely on pesticides for crop protection, yet few receive formal training on safe application practices or protective behaviors. Our research identifies a consistent desire for additional pesticide health and safety training and important gaps in protective behaviors among the respondents, generating actionable insights for targeted interventions and safer agricultural practices.