Title: Barriers to the prevention of heat-related illnesses among small-scale farmers in Vietnam

Abstract

Introduction: Accounted for one-third of the country's workforce, Vietnamese rice farmers are at a high risk of heat-related illnesses (HRI) due to a high level of heat exposure without sufficient preventive measures. Objective: To explore barriers in heat prevention practices among Vietnamese rice farmers in order to develop an HRI prevention program. Method: A semi-structured survey with a convenience sample of 379 rice farmers was conducted in Hatinh Province, Vietnam. The study used descriptive analyses to identify the health effects of heat on farmers and a theme analysis to identify barriers to applying heat prevention measures. Results: Participants were all self-employed and small-scale farmers cultivating less than 0.5 hectares of land. 83.4% of farmers experienced at least one HRI symptom during the last summer harvest season (August to September 2021), and 60.4% were concerned about adverse long-term health effects of heat exposure. Heat prevention practice was hampered by policy and social support barriers. Heat prevention programs have not been applied to farmers because they were considered a part of the informal economy and were not protected by occupational safety regulations. No one reported attending training/community meetings related to HRI prevention and HRI first aid procedures, nor receiving guidelines on appropriate clothing for hot weather (e.g., material, colour, coverage). Moreover, there were no public toilets, shade structures, and electrical outlets in the fields, which affected farmers' drinking and resting behaviours. One-third of female participants did not drink sufficient water when working in the fields for fear of not being able to go to the restroom, and 55% of farmers took a break at places without shades and electric fans. Conclusion: Vietnamese farmers face many social support and policy barriers that put them at a high risk of HRI. The findings suggest a need to provide safety training, public toilets, shades, and cool-down resting places to prevent HRI among farmers.