Background: Farmer using commercially available chemical pesticides are at high risk to develop various pesticide-related-illnesses. To mitigate the adverse effect of pesticides, it is crucial for famers to wear Personal Protective Equipment (PPE). This study aimed to assess the factors influencing knowledge, attitude, and practice (KAP) of PPE use among farmers using pesticides in mid-hills of Nepal. Methods: We conducted a cross-sectional study among 256 farmers in Kirtipur Municipality. We collected data using structured questionnaire via telephone. Bi-variate and multivariate logistic regression was done to identify the association between individual, household and farming related characteristic with knowledge, attitude, and practice of PPE use. Results: The study found that the knowledge, attitude, and practice of PPE use was 53.75%, 55.11%, and 47.16%, respectively. The farmers with primary level schooling (AOR= 2.63; 95% CI 1.00-6.88) and secondary level schooling or higher (AOR= 4.19; 95% CI 1.64-0.68) had higher odds of having knowledge on PPE use rather than the farmers with no formal schooling.  Farmers of upper lower socioeconomic status had higher odds (AOR=6.40; 95% CI 1.68-24.45) of having positive attitude towards PPE use compared to farmers of upper middle and upper socio-economic status. On the contrary, farmers with good knowledge (AOR=0.20; CI 0.09-0.48) and experience of pesticide-related-illness (AOR=0.29; 95% CI 0.13-0.65) had lower odds of having positive attitude towards PPE use. Married farmers (AOR=10.63; 95% CI 1.11-101.95), farmers using pesticides for more than 10 years (AOR=5.22; 95% CI 1.27-21.43), and farmers using pesticides for 10 hours or more in their lifetime (AOR=4.86; 95% CI 1.63-14.50) had higher odds of wearing basic set of PPE while handling pesticides. However, farmers who were involved in farming for more than 10 years (AOR=0.26; 95% CI 0.07-1.03), farmers who were using pesticide applying methods other than knapsack sprayer (AOR=0.03; 95% CI 0.00-0.34), and farmers having positive attitude towards PPE use (AOR=0.28; 95% CI 0.11-0.70) had lower odds of wearing basic set of PPE while handling pesticides. Conclusion: Farmers in Nepal have a positive outlook on PPE use but multitude of factors including knowledge, farming related factors and socio-economic condition have acted as barrier to its use. Tailored educational programs that not only encompasses knowledge dissemination but also cultivation of positive safety attitudes towards PPE can help increase PPE use.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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Ethical approval was obtained from the Institutional Review Committee (IRC) of Patan Academy of Health Sciences (PAHS)- PAHS IRC Reference PHP2107221558.

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