This study aimed to assess multidimensional occupational hazards—chemical, ergonomic, and accidental—and their associations with health outcomes among sugarcane farmers. A cross-sectional study was conducted among 120 sugarcane farmers in Suphanburi Province. Data were collected through structured interviews, ergonomic assessments using the Rapid Entire Body Assessment (REBA), and biomonitoring of organophosphate metabolites in urine (n=47). Descriptive and multivariable logistic regression analyses were performed. The majority were long-term farmers (mean experience 23.6±14.6 years) with high physical workloads and low economic resources. Nearly half (45.0%) had high ergonomic risk scores, 80.0% reported musculoskeletal pain, and 74.2% experienced acute symptoms within 24 hours after pesticide spraying. No organophosphate metabolites were detected in urine samples. High REBA scores and more than one harvest work cycle were significantly associated with acute symptoms and musculoskeletal disorders (p<0.05). Sugarcane farmers face overlapping ergonomic and chemical hazards that synergistically affect their health. Integrated preventive strategies—combining ergonomic redesign, pesticide safety training, and biomonitoring surveillance—are essential to mitigate multidimensional occupational risks and promote sustainable agricultural health. However, due to the cross-sectional design, causal relationships could not be established. In addition, biomonitoring based on single-spot urine samples from a subsample may not fully capture long-term, intermittent, or low-level pesticide exposure; therefore, future studies employing longitudinal designs and repeated biomonitoring are warranted to address these limitations.
Wongsa et al. (2026) studied this question.